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Intraoperative Sensory Signals Predict Prognosis for Patients with Traumatic Cervical Spinal Cord Injury.
John R Renehan1, Ivan B Ye1, Alexandra E Thomson1
1Spine Surgery Division, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
World Neurosurgery
|October 22, 2022
Summary
Intraoperative neuromonitoring signals, specifically upper extremity somatosensory evoked potentials (SSEPs), can predict recovery in patients with complete traumatic cervical spinal cord injury (tCSCI). Detectable SSEPs indicate a greater likelihood of improved motor scores and functional grade conversion.
Area of Science:
- Neurosurgery
- Neurology
- Spinal Cord Injury Research
Background:
- Traumatic cervical spinal cord injury (tCSCI) significantly impacts patient recovery and prognosis.
- Intraoperative neuromonitoring (IONM) is increasingly used in spinal surgery, but its prognostic value in tCSCI remains understudied.
Purpose of the Study:
- To investigate the utility of IONM, specifically somatosensory evoked potentials (SSEPs), as a prognostic tool for recovery in patients with tCSCI.
- To determine if detectable SSEP signals during surgery correlate with improved neurological outcomes.
Main Methods:
- Retrospective review of prospectively collected data from 49 patients undergoing decompression and surgical fixation for tCSCI.
- Comparison of American Spinal Injury Association (ASIA) motor scores and Impairment Scale grade conversion rates between patients with and without detectable intraoperative SSEPs (lower and upper extremity).
Main Results:
- Detectable lower extremity SSEPs were more frequent in incomplete tCSCI (56.3%) than complete tCSCI (23.5%).
- In patients with complete tCSCI, detectable lower extremity SSEPs correlated with significantly higher ASIA motor scores at final follow-up (57.5 vs. 27.1, P=0.041).
- No significant differences in motor scores or grade conversion were observed for incomplete tCSCI patients based on SSEP detectability.
Conclusions:
- The presence of upper extremity SSEP signals in patients with complete tCSCI is associated with greater improvement in ASIA motor scores.
- Detectable upper extremity SSEPs predict a higher likelihood of ASIA Impairment Scale grade conversion in complete tCSCI cases.
