Investigating the Clinical Utility of Motor Evoked Potential Alert Criteria in Predicting Post-Operative Neurological Outcomes in Spinal Surgery: A Systematic Review and Meta-Analysis.

Background

Motor Evoked Potentials (MEPs) are used during tumour resection and deformity correction surgeries to reduce the occurrence of neurological injury. However, the alert criteria implemented for MEP monitoring is inconsistent across institutions and surgical procedures.

Aim

To determine which MEP alert criteria best predicts the occurrence of post-surgical neurological deficits for tumour resection and deformity correction surgeries.

Method

A systematic review and random-effect meta-analysis were used to assess the sensitivity, specificity, and diagnostic odds ratio of MEP amplitude alert criteria in deformity correction, and tumour resection surgeries.

Results

The search identified 22 papers eligible papers (9 tumour resection, 13 deformity correction). 16 papers showed a low risk of bias, while 6 papers showed a moderate risk of bias. Higher pooled sensitivity and specificity values were observed in deformity correction surgeries (94%, 98% respectively) when compared with tumour resections (75%, 80% respectively). For tumour resection surgeries, pooled sensitivity was highest for the 70% MEP amplitude reduction alert criteria (94%), and pooled specificity was highest for the 50% MEP amplitude reduction alert criteria (95%). Comparatively, for deformity correction surgeries, pooled sensitivity and specificity were highest for the 50/65% MEP amplitude reduction alert criteria (99%, 100% respectively). However, high levels of heterogeneity were observed between studies in both tumour resection and deformity correction surgeries.

Conclusion

Well-designed prospective cohort studies are needed in order to provide a higher level of evidence to allow more reliable conclusions to be drawn from future meta-analyses. Additionally, the current systematic review and meta-analysis identified the need for consistency of reporting across papers and provided recommendations to improve the quality of future research.

Keywords

Intraoperative Monitoring, Alert Criteria, MEPs, Tumour, Scoliosis, Meta-Analysis.