Abstract
Objective: To evaluate whether spinal cord intraoperative monitoring (IOM) with somatosensory and transcranial electrical motor evoked potentials (EPs) predicts adverse surgical outcomes.
Methods: A panel of experts reviewed the results of a comprehensive literature search and identified published studies relevant to the clinical question. These studies were classified according to the evidence-based methodology of the American Academy of Neurology. Objective outcomes of postoperative onset of paraparesis, paraplegia, and quadriplegia were used because no randomized or masked studies were available.
Results and Recommendations: Four Class I and 8 Class II studies met inclusion criteria for analysis. The 4 Class I studies and 7 of the 8 Class II studies reached significance in showing that paraparesis, paraplegia, and quadriplegia occurred in the IOM patients with EP changes compared with the IOM group without EP changes. All studies were consistent in showing all occurrences of paraparesis, paraplegia, and quadriplegia in the IOM patients with EP changes, with no occurrences of paraparesis, paraplegia, and quadriplegia in patients without EP changes. In the Class I studies, 16%–40% of the IOM patients with EP changes developed postoperative-onset paraparesis, paraplegia, or quadriplegia. IOM is established as effective to predict an increased risk of the adverse outcomes of paraparesis, paraplegia, and quadriplegia in spinal surgery (4 Class I and 7 Class II studies). Surgeons and other members of the operating team should be alerted to the increased risk of severe adverse neurologic outcomes in patients with important IOM changes (Level A).
GLOSSARY
- AAN=
- American Academy of Neurology;
- ACNS=
- American Clinical Neurophysiology Society;
- EP=
- evoked potential;
- IOM=
- intraoperative monitoring;
- MEP=
- motor evoked potential;
- SEP=
- somatosensory evoked potential;
- tce=
- transcranial electrical.
Footnotes
Study funding: This evidence-based guideline was funded by the American Academy of Neurology and the American Clinical Neurophysiology Society. No author received honoraria or financial support to develop this document.
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Supplemental data at www.neurology.org
Approved by the AAN Therapeutics and Technology Assessment Subcommittee on February 19, 2011; by the AAN Practice Committee on May 19, 2011; by the AAN Board of Directors on October 14, 2011; and by the ACNS Council on June 11, 2011.
Endorsed by the American Association of Neuromuscular and Electrodiagnostic Medicine on January 3, 2012.
- Received June 17, 2011.
- Accepted October 7, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
Disputes & Debates: Rapid online correspondence
- IONM: The standard of evidence must be both credible and ethical.
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- Re:Re:Intraoperative Neurophysiologic Monitoring: Reply to Ney and van der Goes
- Intraoperative Spinal Cord Monitoring Does Improve Outcomes
- Re:Intraoperative Neurophysiologic Monitoring: Reply to Ney and van der Goes
- Updated Practice Guidelines for IOM - an important step in the right direction
- Re:Updated Practice Guidelines for IOM Fall Short
- Intraoperative Neurophysiologic Monitoring: Reply to Ney and van der Goes
- Updated Practice Guidelines for IOM Fall Short
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