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Clin Neurol Neurosurg. 2016 Apr;143:9-14. doi: 10.1016/j.clineuro.2016.02.007. Epub 2016 Feb 9.

Significance of multimodal intraoperative monitoring for the posterior cervical spine surgery.

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Department of Neurosurgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Republic of Korea.
Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea.
Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea. Electronic address:



The aim of this study was to evaluate the efficacy of multimodal neurophysiologic intra-operative monitoring (IOM) in a cohort of patients who underwent posterior cervical surgery.


A total 182 patients were included in this study. Multi-modal intraoperative monitoring (MIOM, somatosensory-evoked potentials: SSEP/transcranial motor-evoked potentials: TCe-MEP/spontaneous-electromyography: S-EMG) was performed in a consecutive series of 129 patients and the other 53 patients (control group) did not. We classified all patients into a high-cervical (H-C) operation group or a low-cervical (L-C) operation group, based on the level of the surgery and analyzed respectively.


One hundred-eleven cases (86%) showed true negative results. Fourteen patients (9 cases- H-C operation, 5 cases- L-C operation) met the criteria of neurophysiologic changes during operation. Of these, 10 cases were restored to normal during operation spontaneously (7 cases) or with surgical manipulation (all 3 cases were related to H-C operation). All unrestored neurophysiologic cases (n=4) showed new post-operative neurological deficits. Four patients showed neurological deficits without any changes in MIOM (false negative, 3 cases--delayed onset C5 palsy, 1 case--C8 palsy).


Proper application of MIOM may be useful to detect intraoperative neurological injury during the posterior cervical operations and improve surgical outcomes especially in subgroup of H-C operation. However, the efficacy of MIOM may be restricted to detect and prevent the delayed onset C5 palsy.


High cervical operation; Low cervical operation; Multi-modal intraoperative monitoring; Posterior cervical spine surgery

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