Funaba Masahiro, Kanchiku Tsukasa, Yoshida Go, Ushirozako Hiroki, Kurosu Kenta, Segi Naoki, Ando Muneharu, Kawabata Shigenori, Yamada Kei, Iwasaki Hiroshi, Taniguchi Shinichirou, Shigematsu Hideki, Tadokoro Nobuaki, Takahashi Masahito, Yamamoto Naoya, Wada Kanichiro, Yasuda Akimasa, Hashimoto Jun, Morito Shinji, Seki Shoji, Kobayashi Kazuyoshi, Takatani Tsunenori, Fujiwara Yasushi, Nakanishi Kazuyoshi, Matsuyama Yukihiro, Imagama Shiro, Sakai Takashi, Takeshita Katsushi
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan.
Spine (Phila Pa 1976). 2025 Jul 17. doi: 10.1097/BRS.0000000000005455.
A multicenter observational study.
To evaluate and compare the diagnostic performance and clinical value of transcranial motor-evoked potentials (Tc-MEPs) in predicting postoperative paralysis in degenerative cervical myelopathy (DCM), specifically on stratifying true-positive alerts in fusion versus decompression surgeries.
Tc-MEP monitoring is widely used to detect intraoperative motor deficits, but its accuracy and predictive value in different surgical approaches remain unclear.
A total of 3,813 patients with DCM who underwent cervical spine surgery were analyzed. Tc-MEP alerts were defined as a ≥70% reduction in amplitude. Postoperative paralysis was categorized as upper limb palsy or lower limb palsy. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of Tc-MEP alerts were calculated. Multivariate logistic regression analysis identified independent predictors of true-positive alerts.
Postoperative motor paralysis occurred in 1.36% (52/3,778) of cases. The Tc-MEP sensitivity was 57.7%, specificity 93.2%, PPV 10.6%, and NPV 99.4%. Fusion surgery had a significantly higher postoperative paralysis rate (3.7% in posterior decompression with fusion [PDF] vs. 0.8% in posterior decompression alone). Fusion surgery was an independent predictor of true-positive alerts (OR = 4.62, 95% CI: 1.69-12.66), while non-attributed alerts were the primary cause of false positives (OR = 0.036, 95% CI: 0.004-0.37).
Tc-MEP alerts showed higher PPV in fusion surgery, reflecting the greater risk profile in these procedures. However, the consistently high NPV across all surgical approaches supports the broad utility of Tc-MEP in ensuring intraoperative neurological safety. This study provides the first large-scale, stratified analysis of Tc-MEP alert outcomes in fusion versus decompression surgery, offering actionable insights for intraoperative neuromonitoring in complex DCM cases.
一项多中心观察性研究。
评估和比较经颅运动诱发电位（Tc-MEPs）在预测退行性颈椎病（DCM）术后瘫痪方面的诊断性能和临床价值，特别是在区分融合手术与减压手术中的真阳性警报方面。
Tc-MEP监测广泛用于检测术中运动功能缺损，但其在不同手术方式中的准确性和预测价值仍不明确。
对3813例行颈椎手术的DCM患者进行分析。Tc-MEP警报定义为波幅降低≥70%。术后瘫痪分为上肢麻痹或下肢麻痹。计算Tc-MEP警报的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。多因素逻辑回归分析确定真阳性警报的独立预测因素。
1.36%（52/3778）的病例发生术后运动性瘫痪。Tc-MEP的敏感性为57.7%，特异性为93.2%，PPV为10.6%，NPV为99.4%。融合手术的术后瘫痪率显著更高（后路减压融合术[PDF]为3.7%，单纯后路减压术为0.8%）。融合手术是真阳性警报的独立预测因素（OR = 4.62，95%CI：1.69 - 12.66），而非归因警报是假阳性的主要原因（OR = 0.036，95%CI：0.004 - 0.37）。
Tc-MEP警报在融合手术中显示出更高的PPV，反映了这些手术中更大的风险特征。然而，所有手术方式中始终较高的NPV支持了Tc-MEP在确保术中神经安全方面的广泛实用性。本研究首次对融合手术与减压手术中的Tc-MEP警报结果进行了大规模分层分析，为复杂DCM病例的术中神经监测提供了可操作的见解。
