Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Although rare, neurologic deficit is one of the most devastating complications of spine surgery (Fehlings et al, 2009). ). The incidence of severe postoperative neurologic sequelae has been reported to be 0.46% for anterior cervical discectomy (Clark, 1998), and 20-65.4% for decompression of spinal cord tumours or trauma (Cristante et al, 1994; Constantini et al, 2000; Husian et al, 2008). Thus, within the past two decades, increased emphasis has been placed on developing intraoperative neurophysiologic methods to accurately monitor the integrity of the spinal cord during spinal surgery. Currently, one such widely used technique is SSEP. SSEP monitoring has been utilized with great success in scoliosis and thoracolumbar spine surgery where it has been credited with reducing the incidence of neurological complications from 4{u2013}6.9% to 0{u2013}0.7% (Deutch et al, 2009) (Epstein et al, 1993) (Fehlings et al, 2009) (Gonzalez et al, 2009). The combined use of transcranial electric motor evoked potentials (tceMEP) in conjunction with SSEPs increases the ability to detect intraoperatively possible spinal cord compromise. In single or multilevel anterior cervical decompression and fusion for cervical radiculopathy without myelopathy,the use of tceMEP in conjunction with SSEP monitoring increases the sensitivity (from 33.3 to 100%), specificity (from 95.6 to 98.1%), positive predictive value (from 33.3 to 75.0%), negative predictive value (from 97.7 to 100%), and efficiency (from 91.7 to 98.2%) of detecting truly clinically significant events compared to SSEP monitoring alone. Due to this and other reports of SSEP's low sensitivity and positive predictive value, some have more recently suggested using tceMEP monitoring in conjunction with SSEP tracings during cervical spine surgery (McDonald et al, 2007)

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