Application of Intraoperative Neurophysiological Monitoring in Kyphoscoliosis Osteotomy Revision Surgery

Abstract：Objective To evaluate the clinical value of transcranial electric motor evoked potentials (TCeMEP) and somatosensory evoked potentials(SSEP) monitoring in spinal kyphoscoliosis osteotomy revision surgery.Methods A retrospective study was performed in 176 Kyphoscoliosis patients who were takenosteotomyrevision surgery under total anesthesia from March 2011 to March 2016.Intraoperative neurophysiological monitoring data including SSEP and TCeMEP were collected.SSEP was attempted in 176 patients,meanwhile TCeMEPwas attempted in 134 patients.The monitoring results are identified andanalyzed.The true and false positive rate,true and false negative rate,positive predictive value,negative predictive value,sensitivity and specifi-city of SSEP and TCeMEP and combined use of SSEP and TCeMEP were calculated,respectively.Results SSEP was successful attempted in 162 patients(92.0%),and TCeMEP was successful attempted in 109 patients(81.3%).By combined using SSEP and TCeMEP,the successful rate increased to 92.5%(124/134).The overall incidence of significant alerts was 8.6%(14/162) and overall permanent neurological deficit was 1.9%(3/162).The sensitivity and specificity were 72.7% and 98.7% for SSEP,90.9% and 98.0% for TCeMEP,respectively.The sensitivity and specificity were 100% and 98.2% by combined using.The positive and negative predictive values of SSEP&TCeMEP were 85.7% and 100%,higher than SSEP alone(80.0% & 98.0%) and TceMEP alone(83.3% & 99.0%).Conclusion Kyphoscoliosis revision surgery is complex,but it can greatly decrease the risk of operation by usingSSEP and TCeMEP.We suggest intraoperative neurophysiological monitoring is the current gold standard for kyphoscoliosis osteotomy revision surgery.