• Parthasarathy D Thirumala, Samyuktha R Melachuri, Jaspreet Kaur, David Ninaci, Manasa K Melachuri, Miguel E Habeych, Donald J Crammond, and Jeffrey R Balzer.
• *Department of Neurological Surgery, Pittsburgh, PA †Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
• Spine. 2017 Apr 1; 42 (7): 490-496.

Study DesignThis study examined the diagnostic accuracy of significant changes of somatosensory evoked potentials (SSEPs) to evaluate and predict postoperative neurological deficits after posterior cervical fusions (PCF). Eight hundred forty six eligible patients underwent PCF at the University of Pittsburgh Medical Center (UPMC), from 2010 to 2012.ObjectiveTo assess the specificity and sensitivity of intraoperative monitoring in predicting postoperative neurological deficits during PCF.Summary Of Background DataWe calculated the predictive value, including sensitivity and specificity, of changes in SSEPs to identify neurological deficits postoperatively. We used a receiver operating characteristic (ROC) curve with SSEP categories as cutoff values to further evaluate the diagnostic accuracy of change in SSEPs and postoperative neurological deficit.MethodsAll patients had preposition baselines and continuous SSEP monitoring throughout the surgery. Statistical analysis was completed using SPSS version 22 (IBM Corp., Armonk, NY).ResultsAge and sex did not influence outcomes. Obesity affected patient outcome. The SSEP categories of significant changes and loss of responses resulted in a sensitivity/specificity of 0.30/0.96 and 0.16/0.98, respectively. The receiver operating characteristic curve has an area under the curve for significant change in/loss of SSEPs of 0.62/0.65 with a 95% confidence interval of 0.525 to 0.714/0.509 to 0.797.ConclusionSignificant SSEP changes during PCF are a very specific but poorly sensitive indicator of postoperative neurological deficits. The odds ratio for significant changes in SSEPs and loss of waveforms was 9.80 and 11.82, respectively, with a 95% confidence interval of 4.695 to 20.46 and 4.45 to 31.41, respectively.Level Of Evidence1.

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