Machine Learning Application of Transcranial Motor-Evoked Potential to Predict Positive Functional Outcomes of Patients.

Intraoperative neuromonitoring (IONM) has been used to help monitor the integrity of the nervous system during spine surgery. Transcranial motor-evoked potential (TcMEP) has been used lately for lower lumbar surgery to prevent nerve root injuries and also to predict positive functional outcomes of patients. There were a number of studies that proved that the TcMEP signal's improvement is significant towards positive functional outcomes of patients. In this paper, we explored the possibilities of using a machine learning approach to TcMEP signal to predict positive functional outcomes of patients. With 55 patients who underwent various types of lumbar surgeries, the data were divided into 70 : 30 and 80 : 20 ratios for training and testing of the machine learning models. The highest sensitivity and specificity were achieved by Fine KNN of 80 : 20 ratio with 87.5% and 33.33%, respectively. In the meantime, we also tested the existing improvement criteria presented in the literature, and 50% of TcMEP improvement criteria achieved 83.33% sensitivity and 75% specificity. But the rigidness of this threshold method proved unreliable in this study when different datasets were used as the sensitivity and specificity dropped. The proposed method by using machine learning has more room to advance with a larger dataset and various signals' features to choose from.