Sensitivity and Specificity of Intraoperative Neurophysiological Monitoring in Lumbar Spinal Surgery: A Meta-Analysis

Abstract

Our meta-analysis aimed to evaluate the specificity and sensitivity of various intraoperative neurophysiological monitoring (IONM) modalities during lumbar spinal surgeries, with a focus on their practical implications. Sensitivity and specificity are essential measures for assessing the effectiveness of IONM. Sensitivity refers to a test's ability to accurately detect patients with a neurological deficit, ensuring that no impairment is overlooked. Specificity represents the test’s ability to correctly identify patients without a deficit, minimizing the occurrence of false positives and unnecessary concerns. The modalities examined included Somatosensory Evoked Potentials (SSEPs), Electromyography (EMG), and Motor-Evoked Potentials (MEPs).

Our findings suggest that utilizing a multimodal approach significantly enhances the accuracy of neurological monitoring, providing practical benefits for surgeons and patients alike. By employing two or more modalities simultaneously, comprehensive observation is achieved, where the strengths of one modality complement the limitations of another, ultimately improving the detection of potential complications. For instance, SSEPs monitor sensory pathways, while MEPs assess motor pathways, and together, they provide a more complete picture of spinal cord function. EMG further assists by detecting muscle responses, indicating nerve function. Thus, multimodal IONM is the most effective way to reduce the risk of neurological injury, improve surgical outcomes, and ensure optimal patient health during lumbar spine surgery.