Academic Journal
Stepwise intensity adjustment reduces false positives in transcranial motor evoked potential monitoring during pediatric spine surgery.
| Τίτλος: | Stepwise intensity adjustment reduces false positives in transcranial motor evoked potential monitoring during pediatric spine surgery. |
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| Συγγραφείς: | Hashimoto T; Department of Clinical Engineering, National Hospital Organization Kobe Medical Center, Kobe, Hyogo, Japan. Electronic address: hashimoto.tomohisa.qf@mail.hosp.go.jp., Uno K; Department of Orthopedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Hyogo, Japan., Suzuki T; Department of Orthopedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Hyogo, Japan., Ito M; Department of Orthopedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Hyogo, Japan. |
| Πηγή: | Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology [Clin Neurophysiol] 2026 Oct; Vol. 190, pp. 2111975. Date of Electronic Publication: 2026 Jun 12. |
| 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): | Evoked Potentials, Motor*/physiology , Intraoperative Neurophysiological Monitoring*/methods , Intraoperative Neurophysiological Monitoring*/standards , Spine*/surgery, Humans ; Female ; Retrospective Studies ; Male ; Child ; False Positive Reactions ; Child, Preschool ; Adolescent ; Infant |
| Περίληψη: | Objective: Transcranial motor evoked potential (TcMEP) monitoring during pediatric spinal deformity surgery has high false-positive (FP) rates. We evaluated whether a Stepwise Adjustment Technique (SAT) improves diagnostic performance compared with a fixed-intensity (FI) protocol. Methods: We retrospectively reviewed 881 pediatric patients (FI, n = 402; SAT, n = 479). In the SAT protocol, when TcMEP amplitude decreased by ≥ 80%, stimulation intensity was increased stepwise up to 200 mA to assess waveform recovery. Diagnostic performance and alert outcomes were compared. Results: Initial TcMEP decreases were similar between groups (FI, 27.1% vs. SAT, 27.3%). In the SAT group, 61.8% (81/131) of decreases resolved after intensity adjustment and were not adjudicated as TcMEP alerts. For the final amplitude ratio at closure, SAT showed higher specificity than FI (0.97 vs. 0.74) while maintaining high sensitivity. Interrupted time-series analysis showed an immediate improvement in the final ratio after SAT implementation (+11.41%, p = 0.002). Conclusions: In pediatric spine surgery, SAT improved TcMEP specificity by reducing false-positive alerts without compromising sensitivity. Although this approach may be particularly useful in spine surgery, caution is warranted where stimulation-threshold elevation is considered an important warning sign. Significance: SAT provides a practical framework for repeated TcMEP assessment during spine surgery. (Copyright © 2026 International Federation of Clinical Neurophysiology. 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. |
| Contributed Indexing: | Keywords: Anesthetic fade; False positive; Intraoperative neurophysiological monitoring; Pediatric spinal deformity; Stepwise adjustment technique; Transcranial motor evoked potentials |
| Entry Date(s): | Date Created: 20260616 Date Completed: 20260812 Latest Revision: 20260812 |
| Update Code: | 20260813 |
| DOI: | 10.1016/j.clinph.2026.2111975 |
| PMID: | 42302670 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1872-8952 |
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| DOI: | 10.1016/j.clinph.2026.2111975 |