Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy

Daniel K. Resnick, Paul A. Anderson, Michael G. Kaiser, Michael W. Groff, Robert F. Heary, Langston T. Holly, Praveen V. Mummaneni, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, Paul G. Matz

Research output: Contribution to journalReview article

43 Citations (Scopus)

Abstract

Object. The objective of this systematic review was to use evidence-based medicine to examine the diagnostic and therapeutic utility of intraoperative electrophysiological (EP) monitoring in the surgical treatment of cervical degenerative disease. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to cervical spine surgery and EP monitoring. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. The reliance on changes in EP monitoring as an indication to alter a surgical plan or administer steroids has not been observed to reduce the incidence of neurological injury during routine surgery for cervical spondylotic myelopathy or cervical radiculopathy (Class III). However, there is an absence of study data examining the benefit of altering a surgical plan due to EP changes. Conclusions. Although the use of EP monitoring may serve as a sensitive means to diagnose potential neurological injury during anterior spinal surgery for cervical spondylotic myelopathy, the practitioner must understand that intraoperative EP worsening is not specific - it may not represent clinical worsening and its recognition does not necessarily prevent neurological injury, nor does it result in improved outcome (Class II). Intraoperative improvement in EP parameters/indices does not appear to forecast outcome with reliability (conflicting Class I data).

Original languageEnglish (US)
Pages (from-to)245-252
Number of pages8
JournalJournal of Neurosurgery: Spine
Volume11
Issue number2
DOIs
StatePublished - Aug 1 2009

Fingerprint

Radiculopathy
Spinal Cord Diseases
Guidelines
Wounds and Injuries
Medical Subject Headings
National Library of Medicine (U.S.)
Intraoperative Monitoring
Peer Review
Evidence-Based Medicine
Spine
Joints
Steroids
Databases
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Neurology
  • Surgery

Keywords

  • Electrophysiological monitoring
  • Myelopathy
  • Practice guidelines
  • Radiculopathy
  • Spinal surgery
  • Treatment outcome

Cite this

Resnick, Daniel K. ; Anderson, Paul A. ; Kaiser, Michael G. ; Groff, Michael W. ; Heary, Robert F. ; Holly, Langston T. ; Mummaneni, Praveen V. ; Ryken, Timothy C. ; Choudhri, Tanvir F. ; Vresilovic, Edward J. ; Matz, Paul G. / Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy. In: Journal of Neurosurgery: Spine. 2009 ; Vol. 11, No. 2. pp. 245-252.
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title = "Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy",
abstract = "Object. The objective of this systematic review was to use evidence-based medicine to examine the diagnostic and therapeutic utility of intraoperative electrophysiological (EP) monitoring in the surgical treatment of cervical degenerative disease. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to cervical spine surgery and EP monitoring. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. The reliance on changes in EP monitoring as an indication to alter a surgical plan or administer steroids has not been observed to reduce the incidence of neurological injury during routine surgery for cervical spondylotic myelopathy or cervical radiculopathy (Class III). However, there is an absence of study data examining the benefit of altering a surgical plan due to EP changes. Conclusions. Although the use of EP monitoring may serve as a sensitive means to diagnose potential neurological injury during anterior spinal surgery for cervical spondylotic myelopathy, the practitioner must understand that intraoperative EP worsening is not specific - it may not represent clinical worsening and its recognition does not necessarily prevent neurological injury, nor does it result in improved outcome (Class II). Intraoperative improvement in EP parameters/indices does not appear to forecast outcome with reliability (conflicting Class I data).",
keywords = "Electrophysiological monitoring, Myelopathy, Practice guidelines, Radiculopathy, Spinal surgery, Treatment outcome",
author = "Resnick, {Daniel K.} and Anderson, {Paul A.} and Kaiser, {Michael G.} and Groff, {Michael W.} and Heary, {Robert F.} and Holly, {Langston T.} and Mummaneni, {Praveen V.} and Ryken, {Timothy C.} and Choudhri, {Tanvir F.} and Vresilovic, {Edward J.} and Matz, {Paul G.}",
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Resnick, DK, Anderson, PA, Kaiser, MG, Groff, MW, Heary, RF, Holly, LT, Mummaneni, PV, Ryken, TC, Choudhri, TF, Vresilovic, EJ & Matz, PG 2009, 'Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy', Journal of Neurosurgery: Spine, vol. 11, no. 2, pp. 245-252. https://doi.org/10.3171/2009.2.SPINE08730

Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy. / Resnick, Daniel K.; Anderson, Paul A.; Kaiser, Michael G.; Groff, Michael W.; Heary, Robert F.; Holly, Langston T.; Mummaneni, Praveen V.; Ryken, Timothy C.; Choudhri, Tanvir F.; Vresilovic, Edward J.; Matz, Paul G.

In: Journal of Neurosurgery: Spine, Vol. 11, No. 2, 01.08.2009, p. 245-252.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy

AU - Resnick, Daniel K.

AU - Anderson, Paul A.

AU - Kaiser, Michael G.

AU - Groff, Michael W.

AU - Heary, Robert F.

AU - Holly, Langston T.

AU - Mummaneni, Praveen V.

AU - Ryken, Timothy C.

AU - Choudhri, Tanvir F.

AU - Vresilovic, Edward J.

AU - Matz, Paul G.

PY - 2009/8/1

Y1 - 2009/8/1

N2 - Object. The objective of this systematic review was to use evidence-based medicine to examine the diagnostic and therapeutic utility of intraoperative electrophysiological (EP) monitoring in the surgical treatment of cervical degenerative disease. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to cervical spine surgery and EP monitoring. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. The reliance on changes in EP monitoring as an indication to alter a surgical plan or administer steroids has not been observed to reduce the incidence of neurological injury during routine surgery for cervical spondylotic myelopathy or cervical radiculopathy (Class III). However, there is an absence of study data examining the benefit of altering a surgical plan due to EP changes. Conclusions. Although the use of EP monitoring may serve as a sensitive means to diagnose potential neurological injury during anterior spinal surgery for cervical spondylotic myelopathy, the practitioner must understand that intraoperative EP worsening is not specific - it may not represent clinical worsening and its recognition does not necessarily prevent neurological injury, nor does it result in improved outcome (Class II). Intraoperative improvement in EP parameters/indices does not appear to forecast outcome with reliability (conflicting Class I data).

AB - Object. The objective of this systematic review was to use evidence-based medicine to examine the diagnostic and therapeutic utility of intraoperative electrophysiological (EP) monitoring in the surgical treatment of cervical degenerative disease. Methods. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to cervical spine surgery and EP monitoring. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Results. The reliance on changes in EP monitoring as an indication to alter a surgical plan or administer steroids has not been observed to reduce the incidence of neurological injury during routine surgery for cervical spondylotic myelopathy or cervical radiculopathy (Class III). However, there is an absence of study data examining the benefit of altering a surgical plan due to EP changes. Conclusions. Although the use of EP monitoring may serve as a sensitive means to diagnose potential neurological injury during anterior spinal surgery for cervical spondylotic myelopathy, the practitioner must understand that intraoperative EP worsening is not specific - it may not represent clinical worsening and its recognition does not necessarily prevent neurological injury, nor does it result in improved outcome (Class II). Intraoperative improvement in EP parameters/indices does not appear to forecast outcome with reliability (conflicting Class I data).

KW - Electrophysiological monitoring

KW - Myelopathy

KW - Practice guidelines

KW - Radiculopathy

KW - Spinal surgery

KW - Treatment outcome

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