Academic Journal
Intraoperative neuromonitoring in degenerative cervical myelopathy surgery: a systematic review and meta-analysis of diagnostic accuracy and postoperative neurological outcomes.
| Τίτλος: | Intraoperative neuromonitoring in degenerative cervical myelopathy surgery: a systematic review and meta-analysis of diagnostic accuracy and postoperative neurological outcomes. |
|---|---|
| Συγγραφείς: | Aghaei MM; Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of., Babaie A; Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of., Bagherzadeh S; Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of., Paeenmahali A; Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of., Roohollahi F; Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of. faramarzroohollahi@yahoo.com., Greenberg M; Department of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA., Kumar J; Department of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA., Kim P; Department of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA., Rostami M; Department of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA. mohsenrostami@usf.edu., Alikhani P; Department of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA. |
| Πηγή: | European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2026 Sep; Vol. 35 (9), pp. 5236-5251. Date of Electronic Publication: 2026 Jul 08. |
| Τύπος έκδοσης: | Journal Article; Systematic Review; Meta-Analysis |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 9301980 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-0932 (Electronic) Linking ISSN: 09406719 NLM ISO Abbreviation: Eur Spine J Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Heidelberg, Federal Republic of Germany : Springer-Verlag, c1992- |
| Ιατρικοί όροι (MeSH): | Cervical Vertebrae*/surgery , Intraoperative Neurophysiological Monitoring*/methods , Spinal Cord Diseases*/surgery , Spinal Cord Diseases*/diagnosis , Decompression, Surgical*/adverse effects, Evoked Potentials, Somatosensory/physiology ; Evoked Potentials, Motor/physiology ; Humans |
| Περίληψη: | Objectives: Degenerative cervical myelopathy (DCM) often requires surgical decompression but carries a risk of intraoperative neural injury. Intraoperative neurophysiological monitoring (IONM) is widely used to detect impending spinal cord compromise during such surgery, yet its impact on postoperative neurological outcomes remains debated. This systematic review and meta-analysis evaluated (1) the diagnostic accuracy of IONM modalities - somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and multimodal monitoring - and (2) the effect of IONM versus no IONM on postoperative neurological outcomes in DCM. Methods: Conducted under PRISMA and PRISMA-DTA guidelines (PROSPERO: CRD420251133125), we systematically searched PubMed, Embase, Scopus, and the Cochrane Library through August 2025. Eligible studies involved adult DCM surgery with IONM. Two meta-analyses were performed: a diagnostic test accuracy meta-analysis (pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) for SSEP, MEP, and multimodal IONM), and a comparative meta-analysis (pooled risk ratios (RR) of new or worsened postoperative neurological deficits with vs. without IONM). Results: Forty-four studies (N = 154,972 patients) were included. SSEP had low pooled sensitivity (~ 33%) but high specificity (~ 99%) (DOR ~ 34, AUC 0.79); MEP showed moderate sensitivity (~ 61%) with high specificity (~ 95%) (DOR ~ 38, AUC 0.91). Multimodal IONM achieved higher sensitivity (~ 76%) with similarly high specificity (~ 94%) (DOR ~ 70, AUC 0.91). Five comparative studies found no significant reduction in postoperative neurological deficits with IONM (pooled RR ≈ 0.6, p = 0.23). Conclusion: Multimodal IONM demonstrates high diagnostic accuracy for detecting intraoperative neural injury in DCM surgery. However, its routine use did not significantly reduce postoperative neurological complication rates in this analysis, a finding that may partly reflect the limited number of comparative studies and the low absolute event rates. Our findings suggest that multimodal IONM should be considered most valuable for high-risk DCM patients and in complex procedures, where early detection of signal changes may alter surgical strategy. (© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) |
| Competing Interests: | Declarations. Competing interests: The authors declare no competing interests. |
| References: | Spine J. 2024 Apr;24(4):572-581. (PMID: 38081458) Clin Neurophysiol Pract. 2021 Feb 03;6:56-62. (PMID: 33665517) Global Spine J. 2021 May;11(4):597-607. (PMID: 32677521) Neurocirugia (Engl Ed). 2022 Sep-Oct;33(5):209-218. (PMID: 36084957) Neurosurg Rev. 2025 Apr 12;48(1):360. (PMID: 40216635) Asian Spine J. 2021 Jun;15(3):317-323. (PMID: 33260284) Neurosurgery. 2021 Sep 15;89(4):704-711. (PMID: 34325471) J Spinal Disord Tech. 2012 Apr;25(2):92-8. (PMID: 22454184) Medicine (Baltimore). 2022 Dec 9;101(49):e31846. (PMID: 36626536) Evid Based Ment Health. 2019 Nov;22(4):153-160. (PMID: 31563865) J Spinal Disord Tech. 2010 May;23(3):170-5. (PMID: 20068473) Spine (Phila Pa 1976). 2022 Jan 1;47(1):E27-E37. (PMID: 34224513) J Clin Med. 2024 May 17;13(10):. (PMID: 38792507) Spine (Phila Pa 1976). 2020 Oct 15;45(20):E1302-E1311. (PMID: 32453241) Spine J. 2025 Sep;25(9):2026-2035. (PMID: 40157429) JAMA. 2018 Jan 23;319(4):388-396. (PMID: 29362800) BMC Neurol. 2020 May 30;20(1):221. (PMID: 32473653) J Clin Neurophysiol. 2003 Apr;20(2):122-8. (PMID: 12766685) J Korean Neurosurg Soc. 2021 Jan;64(1):78-87. (PMID: 33355842) Ann Intern Med. 2011 Oct 18;155(8):529-36. (PMID: 22007046) Neurol India. 2022 Sep-Oct;70(Supplement):S263-S268. (PMID: 36412379) Spine (Phila Pa 1976). 2006 Dec 15;31(26):3013-7. (PMID: 17172998) Spine (Phila Pa 1976). 2012 Jul 1;37(15):E913-21. (PMID: 22322375) Spine (Phila Pa 1976). 2016 Mar;41(6):470-5. (PMID: 26966972) J Clin Epidemiol. 2005 Oct;58(10):982-90. (PMID: 16168343) J Neurosurg Sci. 2025 Jun;69(3):260-267. (PMID: 37971495) Spine (Phila Pa 1976). 2007 Dec 15;32(26):3041-6. (PMID: 18091499) J Neurosurg Spine. 2019 Mar 29;31(1):76-86. (PMID: 30925481) Eur Spine J. 1997;6(5):316-23. (PMID: 9391801) Chin Med J (Engl). 2008 Aug 5;121(15):1374-8. (PMID: 18959112) Res Synth Methods. 2021 Jan;12(1):55-61. (PMID: 32336025) Neurosurg Focus. 2013 Jul;35(1):E7. (PMID: 23815252) Spine (Phila Pa 1976). 2002 Nov 15;27(22):2499-502. (PMID: 12435981) J Spine Surg. 2018 Jun;4(2):211-219. (PMID: 30069509) World Neurosurg. 2024 Oct;190:e17-e25. (PMID: 38906464) J Clin Monit Comput. 2019 Feb;33(1):123-132. (PMID: 29667095) Nat Rev Neurol. 2020 Feb;16(2):108-124. (PMID: 31974455) Spine (Phila Pa 1976). 1993 May;18(6):737-47. (PMID: 8516704) Brain. 1972;95(1):87-100. (PMID: 5023093) Spine (Phila Pa 1976). 2025 Oct 15;50(20):1410-1419. (PMID: 40990082) Zhonghua Yi Xue Za Zhi. 2006 Jul 18;86(27):1891-5. (PMID: 17064526) J Neurol Sci. 2017 Oct 15;381:235-239. (PMID: 28991689) Eur Spine J. 2017 Sep;26(9):2404-2409. (PMID: 28620788) Global Spine J. 2024 Mar;14(3_suppl):105S-149S. (PMID: 38632716) J Bone Joint Surg Am. 2004 Jun;86(6):1248-53. (PMID: 15173299) Clin Spine Surg. 2019 Jun;32(5):E221-E227. (PMID: 30608235) Biometrics. 2020 Dec;76(4):1255-1259. (PMID: 32860419) J Clin Monit Comput. 2022 Feb;36(1):247-258. (PMID: 33548015) Eur Spine J. 2019 Mar;28(3):599-610. (PMID: 30560453) J Neurosurg Spine. 2018 Oct;29(4):435-441. (PMID: 30052151) World Neurosurg. 2017 Oct;106:17-25. (PMID: 28619491) Stat Med. 2004 May 15;23(9):1351-75. (PMID: 15116347) Eur Spine J. 2025 Aug;34(8):3389-3397. (PMID: 40442520) Spine Surg Relat Res. 2022 Oct 13;7(1):26-35. (PMID: 36819625) J Neurosurg Spine. 2007 May;6(5):381-5. (PMID: 17542501) |
| Contributed Indexing: | Keywords: Degenerative cervical myelopathy; Intraoperative neuromonitoring; Intraoperative neurophysiological monitoring; Motor evoked potentials; Sensitivity; Somatosensory evoked potentials; Specificity |
| Entry Date(s): | Date Created: 20260707 Date Completed: 20260826 Latest Revision: 20261008 |
| Update Code: | 20261008 |
| DOI: | 10.1007/s00586-026-10187-w |
| PMID: | 42414665 |
| Βάση Δεδομένων: | MEDLINE |
καταχωρήστε σχόλιο πρώτοι!