PMID- 27390917
OWN - NLM
STAT- MEDLINE
DCOM- 20170914
LR  - 20221005
IS  - 1528-1159 (Electronic)
IS  - 0362-2436 (Print)
IS  - 0362-2436 (Linking)
VI  - 42
IP  - 6
DP  - 2017 Mar 15
TI  - Intraoperative Neuromonitoring for Anterior Cervical Spine Surgery: What Is the 
      Evidence?
PG  - 385-393
LID - 10.1097/BRS.0000000000001767 [doi]
AB  - STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: The goal of this 
      study was to (i) assess the risk of neurological injury after anterior cervical 
      spine surgery (ACSS) with and without intraoperative neuromonitoring (ION) and 
      (ii) evaluate differences in the sensitivity and specificity of ION for ACSS. 
      SUMMARY OF BACKGROUND DATA: Although ION is used to detect impending neurological 
      injuries in deformity surgery, it's utility in ACSS remains controversial. 
      METHODS: A systematic search of multiple medical reference databases was 
      conducted for studies on ION use for ACSS. Studies that included posterior 
      cervical surgery were excluded. Meta-analysis was performed using the 
      random-effects model for heterogeneity. Outcome measure was postoperative 
      neurological injury. RESULTS: The search yielded 10 studies totaling 26,357 
      patients. The weighted risk of neurological injury after ACSS was 0.64% 
      (0.23-1.25). The weighted risk of neurological injury was 0.20% (0.05-0.47) for 
      ACDFs compared with 1.02% (0.10-2.88) for corpectomies. For ACDFs, there was no 
      difference in the risk of neurological injury with or without ION (odds ratio, 
      0.726; confidence interval, CI, 0.287-1.833; P = 0.498). The pooled sensitivities 
      and specificities of ION for ACSS are 71% (CI: 48%-87%) and 98% (CI: 92%-100%), 
      respectively. Unimodal ION has a higher specificity than multimodal ION 
      [unimodal: 99% (CI: 97%-100%), multimodal: 92% (CI: 81%-96%), P = 0.0218]. There 
      was no statistically significant difference in sensitivities between unimodal and 
      multimodal [68% vs. 88%, respectively, P = 0.949]. CONCLUSION: The risk of 
      neurological injury after ACSS is low although procedures involving a corpectomy 
      may carry a higher risk. For ACDFs, there is no difference in the risk of 
      neurological injury with or without ION use. Unimodal ION has a higher 
      specificity than multimodal ION and may minimize "subclinical" intraoperative 
      alerts in ACSS. LEVEL OF EVIDENCE: 3.
FAU - Ajiboye, Remi M
AU  - Ajiboye RM
AD  - Department of Orthopedic Surgery, University of California-Los Angeles, Los 
      Angeles, CA.
FAU - Zoller, Stephen D
AU  - Zoller SD
AD  - Department of Orthopedic Surgery, University of California-Los Angeles, Los 
      Angeles, CA.
FAU - Sharma, Akshay
AU  - Sharma A
AD  - Case Western Reserve School of Medicine, Cleveland, OH.
FAU - Mosich, Gina M
AU  - Mosich GM
AD  - Department of Orthopedic Surgery, University of California-Los Angeles, Los 
      Angeles, CA.
FAU - Drysch, Austin
AU  - Drysch A
AD  - Department of Orthopedic Surgery, University of California-Los Angeles, Los 
      Angeles, CA.
FAU - Li, Jesse
AU  - Li J
AD  - Department of Orthopedic Surgery, University of California-Los Angeles, Los 
      Angeles, CA.
FAU - Reza, Tara
AU  - Reza T
AD  - Department of Orthopedic Surgery, University of California-Los Angeles, Los 
      Angeles, CA.
FAU - Pourtaheri, Sina
AU  - Pourtaheri S
AD  - Department of Orthopedic Surgery, University of California-Los Angeles, Los 
      Angeles, CA.
LA  - eng
GR  - T32 AR059033/AR/NIAMS NIH HHS/United States
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Spine (Phila Pa 1976)
JT  - Spine
JID - 7610646
SB  - IM
MH  - Cervical Vertebrae/*surgery
MH  - *Diskectomy/methods
MH  - Humans
MH  - *Monitoring, Intraoperative/methods
MH  - Postoperative Complications/*surgery
MH  - Retrospective Studies
MH  - *Spinal Fusion/methods
PMC - PMC5552368
MID - NIHMS883050
EDAT- 2016/07/09 06:00
MHDA- 2017/09/15 06:00
PMCR- 2018/03/15
CRDT- 2016/07/09 06:00
PHST- 2016/07/09 06:00 [pubmed]
PHST- 2017/09/15 06:00 [medline]
PHST- 2016/07/09 06:00 [entrez]
PHST- 2018/03/15 00:00 [pmc-release]
AID - 00007632-201703150-00010 [pii]
AID - 10.1097/BRS.0000000000001767 [doi]
PST - ppublish
SO  - Spine (Phila Pa 1976). 2017 Mar 15;42(6):385-393. doi: 
      10.1097/BRS.0000000000001767.