P41. Intraoperative neurophysiologic monitoring and neurologic outcomes in orthopedic spine surgery patients without preoperative neurologic deficits

• Published in: The spine journal 2019-09, Vol.19 (9), p.S177-S177
• Main Authors: Hurley, Richard, Fees, Gretchen, Haffner, Max R., Valentine, Erika, Steele, Amy, Nowacki, Douglas, Javidan, Yashar, Roberto, Rolando F., Klineberg, Eric O.
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2019.05.465

Intraoperative neurophysiologic monitoring (IONM) is becoming standard-of-practice for many spine surgeons across the world. Neuromonitoring alerts such as decreased amplitude of motor evoked potentials (MEPs), change in baseline somatosensory evoked potentials (SSEPs), and triggered electromyography (EMG) are followed intraoperatively to help identify and prevent postoperative neurologic complications. Very little is published with respect to long-term clinical outcomes following spine procedures with IONM, but those studies that have been published show postoperative neurologic deficits ranging from 3.2-17.6%. While there is no consensus on existing data regarding these modalities in predicting new neurological deficits intraoperatively, some authors advocate for the use of EMG, SSEPs, and selective MEPs for possibly preventing neurologic injury during spine surgery. Neurologic outcomes were retrospectively analyzed from orthopedic spine surgeries with IONM data from a single institution for up to one year postoperatively to determine the clinical outcomes as well as the sensitivity, specificity, and predictive values of IONM modalities. All neuromonitored cases from a single institution orthopedic spine surgery practice at a level I trauma referral center were gathered and retrospectively analyzed for neurologic outcomes over a one-year period. A total of 460 neuromonitored spine surgeries were performed at a single institution by the orthopedic spine service from January 1, 2017 through December 31, 2017. Of the 460 procdures, 192 met inclusion criteria for patients with normal preoperative sensory and motor baseline exams documented, and at least 3 months of postoperative follow-up data available. There were 4 patients aged 1-12 years, 4 patients aged 13-17 years, 99 patients aged 18-64, and 85 patients aged 65 years or older. There were 94 male and 98 female patients. Surgical procedures included 31 anterior cervical, 12 posterior cervical, 6 posterior cervicothoracic, 16 posterior thoracic, 22 posterior thoracolumbar, 3 combined anterior/posterior lumbar/lumbosacral, and 102 posterior lumbar/lumbosacral. Clinical examination data was collected and reviewed in the outpatient and inpatient settings. Outcomes reviewed included neurologic sensory and motor status preoperatively, perioperatively, and post-operatively at defined time points. All neuromonitored cases from a single institution orthopedic spine surgery practice at a level I trauma referral c