Am. Padberg et al., SOMATOSENSORY-EVOKED AND MOTOR-EVOKED POTENTIAL MONITORING WITHOUT A WAKE-UP TEST DURING IDIOPATHIC SCOLIOSIS SURGERY - AN ACCEPTED STANDARD OF CARE, Spine (Philadelphia, Pa. 1976), 23(12), 1998, pp. 1392-1400
Study Design. This was a retrospective study of 500 patients undergoin
g corrective surgery between 1987 and 1997 for spinal deformity caused
by idiopathic scoliosis. Objectives. To report the sensitivity and sp
ecificity of somatosensory-evoked and neurogenic motor-evoked potentia
ls monitoring and the requirements for an intraoperative wake-up test
for all idiopathic scoliosis surgeries at a single institution. Summar
y of Background Data. Intraoperative monitoring is recommended for use
during corrective spinal surgery. Accepted monitoring standards and r
equirements for an intraoperative wake-up test are still debated. Meth
ods. The study group consisted of 500 patients undergoing corrective s
urgery for idiopathic scoliosis between 1987 and 1997. All patients we
re monitored using somatosensory-evoked and neurogenic motor-evoked po
tential techniques, using a standard protocol developed at this instit
ution. Results. The false-positive rate (significant data change witho
ut postoperative neurologic deficit) was 0.014% (n = 7). The true-posi
tive rate (degradation of data that met warning criteria, with a corre
sponding postoperative neurologic deficit) was 0.004% (n = 2). No fals
e-negative results (normal data during with a postoperative neurologic
deficit) were seen. The sensitivity of combined somatosensory-evoked
and neurogenic motor-evoked potentials data in predicting neurologic s
tatus was 98.6%, and the specificity of normal data predicting normal
findings in a neurologic examination was 100%. Conclusions. Combined s
omatosensory-evoked and neurogenic motor-evoked potentials monitoring
during idiopathic scoliosis surgery represents a standard of care that
obviates the need for an intraoperative wake-up test when reliable da
ta are obtained and maintained.