Somatosensory Evoked Potential Monitoring During Anterior Cervical Discectomy and Fusion

Abstract

In Brief Study Design. A retrospective, multicenter clinical review was conducted. Objective. To examine our experience using somatosensory evoked potential (SSEP) monitoring during anterior cervical discectomy and fusion (ACDF) to determine if monitoring of the spinal cord with SSEPs was helpful in identifying reversible causes of neurologic impairment while performing the procedure. Summary of Background Data. Recent studies have strongly supported the use of SSEP monitoring during complicated and upper-cervical spine surgery. Methods. The complete medical records of 163 patients who underwent ACDF, and who were monitored with SSEPs during the procedure between 1995 and 2002 were retrospectively reviewed. A single observer who was uninvolved with patient care abstracted these medical records. Demographic data, length of symptoms, workers' compensation status, primary diagnosis, preoperative neurologic status, number of levels fused, bone graft type, implants used, SSEP findings, postoperative neurologic status, complications, and recovery from complications were recorded. Final neurologic status was determined through phone contact with patients or outpatient charts of patients who could not be contacted personally. Results. There were 3 false positive (1.8%) intraoperative SSEP findings in which SSEP changes intraoperatively did not reflect a neurologic deterioration after surgery. There was 1 false negative (0.6%) in which a new neurologic deficit occurred after surgery, despite no change in SSEP amplitudes during the operation. There were 2 true negatives (1.2%) in which SSEP monitoring showed a preexisting neurologic deficit, which did not change during the operation. Conclusion. In no instance were positive SSEP findings clinically useful in alerting the surgeon to potential intraoperative complications. Intraoperative SSEP monitoring is not helpful to the surgeon when performing routine ACDF. Additionally, ACDF is a safe procedure with a low rate of neurologic complications. The records of 163 patients who underwent anterior cervical discectomy and fusion, and who were monitored with somatosensory evoked potentials (SSEP) were reviewed to elucidate if intraoperative monitoring was helpful in identifying neurologic injury. SSEP findings were not clinically useful. SSEP monitoring is not helpful when performing anterior cervical discectomy and fusion.