Intraoperative neuromonitoring in degenerative cervical myelopathy surgery: a systematic review and meta-analysis of diagnostic accuracy and postoperative neurological outcomes.
Mohammad Mahdi Aghaei, Armin Babaie, Sadegh Bagherzadeh et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the diagnostic accuracy of intraoperative neurophysiological monitoring (IONM) and its impact on postoperative outcomes in 154,972 patients undergoing surgery for degenerative cervical myelopathy (DCM). While multimodal IONM showed high diagnostic accuracy (sensitivity ~76%, specificity ~94%), it did not significantly reduce postoperative neurological deficits compared to no IONM (pooled RR ≈ 0.6, p = 0.23).
Key findings
- SSEP had low pooled sensitivity (~33%) but high specificity (~99%) with a DOR ~34.
- MEP demonstrated moderate sensitivity (~61%) and high specificity (~95%) with a DOR ~38.
- Multimodal IONM achieved higher sensitivity (~76%) and specificity (~94%) with a DOR ~70.
- No significant reduction in postoperative neurological deficits was found with IONM (pooled RR ≈ 0.6, p = 0.23).
Why it matters
Understanding the effectiveness of IONM in DCM surgery is crucial for clinicians to weigh its benefits against potential costs and to make informed decisions regarding its use in high-risk patients.