• Masahito Takahashi, Shiro Imagama, Kazuyoshi Kobayashi, Kei Yamada, Go Yoshida, Naoya Yamamoto, Muneharu Ando, Shigenori Kawabata, Tsukasa Kanchiku, Yasushi Fujiwara, Shinichirou Taniguchi, Hiroshi Iwasaki, Kanichiro Wada, Hideki Shigematsu, Nobuaki Tadokoro, Hiroki Ushirozako, Masahiro Funaba, Akimasa Yasuda, Kei Ando, Jun Hashimoto, Shinji Morito, Tsunenori Takatani, Toshikazu Tani, and Yukihiro Matsuyama.
• Department of Orthopedic Surgery, Kyorin University, Tokyo, Japan.
• Spine. 2021 Oct 15; 46 (20): E1069-E1076.

Study DesignProspective multicenter cohort study.ObjectiveThe aim of this study was to validate an alarm point of intraoperative neurophysiological monitoring () formulated by the Monitoring Working Group (WG) of the Japanese Society for Spine Surgery and Related Research (JSSR).Summary Of Background DataThe Monitoring WG of the JSSR formulated an alarm point of IONM using transcranial electrical stimulation-muscle motor evoked potentials (Tc(E)-MEPs) and has conducted a prospective multicenter study. The validity of the JSSR alarm point of ≥ 70% decreased in Tc(E)-MEPs for each high-risk surgery and any other spine surgeries has not been verified.MethodsPatients who underwent spine and spinal cord surgery with IONM in 16 Japanese spine centers in the Monitoring WG of the JSSR from 2017 to 2018 were enrolled. The patients were divided into the high-risk surgery group (Group HR) and the common surgery group (Group C). Group HR was defined by ossification of the posterior longitudinal ligament (OPLL), spinal deformity, and spinal cord tumor. Group C was classified as other spine surgeries. The alarm point was defined as a ≥70% decrease in the Tc(E)-MEPs.ResultsIn Group HR, the sensitivity and specificity were 94.4% and 87.0%, respectively. In Group C, the sensitivity and specificity were 63.6% and 91.9%. The sensitivity in Group C was statistically lower than that in Group HR (P < 0.05). In Group HR, the sensitivity and specificity in OPLL were 100% and 86.9%, respectively. The sensitivity and specificity in spinal deformity were 87.5% and 84.8%, respectively, and the sensitivity and specificity in spinal cord tumors were 92.9% and 89.9%, respectively. The sensitivity and specificity in each high-risk surgery showed no significant difference.ConclusionThe alarm point of IONM by the Monitoring WG of the JSSR appeared to be valid for each disease in Group HR. Meanwhile, applying the JSSR alarm point for Group C potentially needed attention.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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