• Masahiro Funaba, Tsukasa Kanchiku, Kazuyoshi Kobayashi, Go Yoshida, Masaaki Machino, Kei Yamada, Hideki Shigematsu, Nobuaki Tadokoro, Hiroki Ushirozako, Masahito Takahashi, Naoya Yamamoto, Shinji Morito, Shigenori Kawabata, Yasushi Fujiwara, Muneharu Ando, Shinichirou Taniguchi, Hiroshi Iwasaki, Kanichiro Wada, Akimasa Yasuda, Jun Hashimoto, Tsunenori Takatani, Kei Ando, Yukihiro Matsuyama, and Shiro Imagama.
• Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
• Spine. 2022 Dec 1; 47 (23): 165916681659-1668.

Study DesignA prospective multicenter observational study.ObjectiveThe aim was to investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in cervical spine surgery and identify factors associated with positive predictive value when Tc-MEP alerts are occurred.Summary Of Background DataThe sensitivity and specificity of Tc-MEP for detecting motor paralysis are high; however, false-positives sometimes occur.Materials And MethodsThe authors examined Tc-MEP in 2476 cases of cervical spine surgeries and compared patient backgrounds, type of spinal disorders, preoperative motor status, surgical factors, and the types of Tc-MEP alerts. Tc-MEP alerts were defined as an amplitude reduction of more than 70% from the control waveform. Tc-MEP results were classified into two groups: false-positive and true-positive, and items that showed significant differences were extracted by univariate analysis and detected by multivariate analysis.ResultsOverall sensitivity was 66% (segmental paralysis: 33% and lower limb paralysis: 95.8%) and specificity was 91.5%. Tc-MEP outcomes were 33 true-positives and 233 false-positives. Positive predictive value of general spine surgery was significantly higher in cases with a severe motor status than in a nonsevere motor status (19.5% vs . 6.7%, P =0.02), but not different in high-risk spine surgery (20.8% vs . 19.4%). However, rescue rates did not significantly differ regardless of motor status (48% vs . 50%). In a multivariate logistic analysis, a preoperative severe motor status [ P =0.041, odds ratio (OR): 2.46, 95% confidence interval (95% CI): 1.03-5.86] and Tc-MEP alerts during intradural tumor resection ( P <0.001, OR: 7.44, 95% CI: 2.64-20.96) associated with true-positives, while Tc-MEP alerts that could not be identified with surgical maneuvers ( P =0.011, OR: 0.23, 95% CI: 0.073-0.71) were associated with false-positives.ConclusionThe utility of Tc-MEP in patients with a preoperative severe motor status was enhanced, even in those without high-risk spine surgery. Regardless of the motor status, appropriate interventions following Tc-MEP alerts may prevent postoperative paralysis.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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