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The impact of neck extension on intraoperative neuromonitoring alerts in cervical myelopathy: A neurophysiological analysis.

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Τίτλος: The impact of neck extension on intraoperative neuromonitoring alerts in cervical myelopathy: A neurophysiological analysis.
Συγγραφείς: Lubbad O; Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom. Electronic address: O.lubbad1@uni.bsms.ac.uk., Spence H; INOMED neurocare, London, United Kingdom., Sinha P; Royal Sussex County Hospital department of neurosurgery, Brighton, United Kingdom., Poole J; INOMED neurocare, London, United Kingdom., Masilamany K; INOMED neurocare, London, United Kingdom., Sheikhali R; Royal Sussex County Hospital department of neurosurgery, Brighton, United Kingdom., Ahmad R; Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom., Morassi GL; Royal Sussex County Hospital department of neurosurgery, Brighton, United Kingdom., Mazarakis NK; Royal Sussex County Hospital department of neurosurgery, Brighton, United Kingdom; Royal College of Surgeons in Ireland Medical School, Dublin, Ireland; Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece.
Πηγή: Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology [Clin Neurophysiol] 2026 Oct; Vol. 190, pp. 2111970. Date of Electronic Publication: 2026 Jun 10.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Elsevier Country of Publication: Netherlands NLM ID: 100883319 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1872-8952 (Electronic) Linking ISSN: 13882457 NLM ISO Abbreviation: Clin Neurophysiol Subsets: MEDLINE
Imprint Name(s): Original Publication: Amsterdam : Elsevier, c1999-
Ιατρικοί όροι (MeSH): Intraoperative Neurophysiological Monitoring*/methods , Spinal Cord Diseases*/surgery , Spinal Cord Diseases*/physiopathology , Cervical Vertebrae*/surgery , Posture*/physiology , Neck*, Humans ; Female ; Male ; Retrospective Studies ; Middle Aged ; Aged ; Magnetic Resonance Imaging ; Adult
Περίληψη: Objective: Neck extension can transiently impair spinal cord conduction in cervical myelopathy, yet posture-dependent intraoperative neurophysiological changes remain poorly characterised. We aimed to define the timing, modality involvement, reversibility, and risk factors of positioning-related intraoperative neurophysiological events during anterior cervical surgery.
Methods: We performed a retrospective analysis of patients undergoing anterior cervical surgery for myelopathy with multimodal intraoperative neurophysiological monitoring. Posture-dependent events were defined as neurophysiological changes occurring during neck extension prior to incision. Occipitocervical extension was quantified using the occipitocervical angle on intraoperative radiographs. Preoperative MRI markers of cord vulnerability were recorded.
Results: Among 117 patients, 18 neurophysiological alerts were identified, of which 12 (66%) occurred during neck extension. These events predominantly involved abrupt TcMEP amplitude reduction and were typically reversible with repositioning. Patients with posture-dependent TcMEP changes demonstrated greater occipitocervical extension and preoperative MRI markers of cord compromise, while subaxial alignment did not differ. Postoperative neurological deficits occurred only in cases with persistent, non-reversible TcMEP reduction at closure (3 events), whereas reversible changes were not followed by deficit.
Conclusions: Neck extension in cervical myelopathy can precipitate reversible, posture-dependent corticospinal conduction failure detectable by TcMEPs.
Significance: These findings suggest that positioning-related neurophysiological changes reflect reduced tolerance of compressed spinal cords to mechanical stress, and highlight the importance of intraoperative positioning as a modifiable determinant of neurological risk.
(Copyright © 2026 The Author(s). Published by Elsevier B.V. All rights reserved.)
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Entry Date(s): Date Created: 20260612 Date Completed: 20260812 Latest Revision: 20260812
Update Code: 20260813
DOI: 10.1016/j.clinph.2026.2111970
PMID: 42284925
Βάση Δεδομένων: MEDLINE
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  Data: The impact of neck extension on intraoperative neuromonitoring alerts in cervical myelopathy: A neurophysiological analysis.
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  Data: <searchLink fieldCode="AU" term="%22Lubbad+O%22">Lubbad O</searchLink>; Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom. Electronic address: O.lubbad1@uni.bsms.ac.uk.<br /><searchLink fieldCode="AU" term="%22Spence+H%22">Spence H</searchLink>; INOMED neurocare, London, United Kingdom.<br /><searchLink fieldCode="AU" term="%22Sinha+P%22">Sinha P</searchLink>; Royal Sussex County Hospital department of neurosurgery, Brighton, United Kingdom.<br /><searchLink fieldCode="AU" term="%22Poole+J%22">Poole J</searchLink>; INOMED neurocare, London, United Kingdom.<br /><searchLink fieldCode="AU" term="%22Masilamany+K%22">Masilamany K</searchLink>; INOMED neurocare, London, United Kingdom.<br /><searchLink fieldCode="AU" term="%22Sheikhali+R%22">Sheikhali R</searchLink>; Royal Sussex County Hospital department of neurosurgery, Brighton, United Kingdom.<br /><searchLink fieldCode="AU" term="%22Ahmad+R%22">Ahmad R</searchLink>; Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.<br /><searchLink fieldCode="AU" term="%22Morassi+GL%22">Morassi GL</searchLink>; Royal Sussex County Hospital department of neurosurgery, Brighton, United Kingdom.<br /><searchLink fieldCode="AU" term="%22Mazarakis+NK%22">Mazarakis NK</searchLink>; Royal Sussex County Hospital department of neurosurgery, Brighton, United Kingdom; Royal College of Surgeons in Ireland Medical School, Dublin, Ireland; Department of Neurosurgery, Hippokratio General Hospital, Aristotle University of Thessaloniki School of Medicine, Thessaloniki, Greece.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Elsevier%22">Elsevier </searchLink><i>Country of Publication: </i>Netherlands <i>NLM ID: </i>100883319 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1872-8952 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2213882457%22">13882457 </searchLink><i>NLM ISO Abbreviation: </i>Clin Neurophysiol <i>Subsets: </i>MEDLINE
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  Data: <searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring%22">Intraoperative Neurophysiological Monitoring*</searchLink>/<searchLink fieldCode="MM" term="%22Intraoperative+Neurophysiological+Monitoring+methods%22">methods</searchLink> <br /><searchLink fieldCode="MM" term="%22Spinal+Cord+Diseases%22">Spinal Cord Diseases*</searchLink>/<searchLink fieldCode="MM" term="%22Spinal+Cord+Diseases+surgery%22">surgery</searchLink> <br /><searchLink fieldCode="MM" term="%22Spinal+Cord+Diseases%22">Spinal Cord Diseases*</searchLink>/<searchLink fieldCode="MM" term="%22Spinal+Cord+Diseases+physiopathology%22">physiopathology</searchLink> <br /><searchLink fieldCode="MM" term="%22Cervical+Vertebrae%22">Cervical Vertebrae*</searchLink>/<searchLink fieldCode="MM" term="%22Cervical+Vertebrae+surgery%22">surgery</searchLink> <br /><searchLink fieldCode="MM" term="%22Posture%22">Posture*</searchLink>/<searchLink fieldCode="MM" term="%22Posture+physiology%22">physiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Neck%22">Neck*</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Retrospective+Studies%22">Retrospective Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Aged%22">Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Magnetic+Resonance+Imaging%22">Magnetic Resonance Imaging</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Neck extension can transiently impair spinal cord conduction in cervical myelopathy, yet posture-dependent intraoperative neurophysiological changes remain poorly characterised. We aimed to define the timing, modality involvement, reversibility, and risk factors of positioning-related intraoperative neurophysiological events during anterior cervical surgery.<br />Methods: We performed a retrospective analysis of patients undergoing anterior cervical surgery for myelopathy with multimodal intraoperative neurophysiological monitoring. Posture-dependent events were defined as neurophysiological changes occurring during neck extension prior to incision. Occipitocervical extension was quantified using the occipitocervical angle on intraoperative radiographs. Preoperative MRI markers of cord vulnerability were recorded.<br />Results: Among 117 patients, 18 neurophysiological alerts were identified, of which 12 (66%) occurred during neck extension. These events predominantly involved abrupt TcMEP amplitude reduction and were typically reversible with repositioning. Patients with posture-dependent TcMEP changes demonstrated greater occipitocervical extension and preoperative MRI markers of cord compromise, while subaxial alignment did not differ. Postoperative neurological deficits occurred only in cases with persistent, non-reversible TcMEP reduction at closure (3 events), whereas reversible changes were not followed by deficit.<br />Conclusions: Neck extension in cervical myelopathy can precipitate reversible, posture-dependent corticospinal conduction failure detectable by TcMEPs.<br />Significance: These findings suggest that positioning-related neurophysiological changes reflect reduced tolerance of compressed spinal cords to mechanical stress, and highlight the importance of intraoperative positioning as a modifiable determinant of neurological risk.<br /> (Copyright © 2026 The Author(s). Published by Elsevier B.V. All rights reserved.)
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  Data: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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        Text: English
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      – TitleFull: The impact of neck extension on intraoperative neuromonitoring alerts in cervical myelopathy: A neurophysiological analysis.
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