Utility of intraoperative neuromonitoring changes in predicting postoperative neurologic deficit in lateral lumbar interbody fusion: A systematic review and meta-analysis.
Prasuna Velur, Vibha Velur, Marvin Gong
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In 30 seconds
This systematic review and meta-analysis evaluated the diagnostic accuracy of intraoperative neuromonitoring (IONM) in predicting postoperative neurologic deficits in patients undergoing lateral lumbar interbody fusion (LLIF). Analyzing data from seven studies involving 1,994 patients, the pooled sensitivity was 79.0% and specificity was 95.9%. The findings highlight the variability in sensitivity based on monitoring modality.
Key findings
- Pooled sensitivity of IONM was 79.0% (95% CI: 73.0-83.9%) and specificity was 95.9% (95% CI: 94.3-97.0%).
- Bivariate model sensitivity was estimated at 99.3% (95% CI: 13.7-100%) and specificity at 98.8% (95% CI: 80.2-99.9%).
- Individual study sensitivity ranged from 28% to 100%, influenced by the monitoring modality used.
- Multimodal protocols with transcranial motor evoked potentials showed superior performance compared to unimodal electromyography.
Why it matters
Understanding the diagnostic accuracy of IONM can help clinicians better assess the risk of neurologic deficits during LLIF procedures. High specificity suggests that positive IONM changes are reliable indicators, while variable sensitivity highlights the need for careful interpretation based on monitoring techniques.
What to keep in mind
High between-study heterogeneity (I2 = 78.8%) and significant bias risk were noted, with the analysis being underpowered due to the limited number of studies.