Diagnostic test accuracy meta-analysis of transcranial motor evoked potential monitoring for the prediction of postoperative neurological deficits in ossification of the posterior longitudinal ligament surgery.
Transcranial motor evoked potential monitoring has high specificity but only moderate sensitivity for neurological deficits after ossification of the posterior longitudinal ligament surgery
Diagnostic test accuracy meta-analysis of transcranial motor evoked potential monitoring for the prediction of postoperative neurological deficits in ossification of the posterior longitudinal ligament surgery.
To quantify the diagnostic accuracy of transcranial motor evoked potential (transcranial motor evoked potential) monitoring for predicting postoperative neurological deficits in adults undergoing decompressive surgery exclusively for ossification of the posterior longitudinal ligament (ossification of the posterior longitudinal ligament), and to characterise heterogeneity sources.
Studies were eligible if they reported extractable 2 × 2 contingency data for transcranial motor evoked potential monitoring in ossification of the posterior longitudinal ligament-exclusive cohorts (≥20 patients); quality was assessed with QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies).
Transcranial motor evoked potential correctly flagged only about half of true neurological deficits
Five studies (990 patients; deficit rate 6.9%) met eligibility.
Positive likelihood ratio (LR+) was 5.47; negative LR- 0.50; diagnostic odds ratio (diagnostic odds ratio) 13.75 (95% CI: 7.11-26.59; I 2 = 0%).
Heterogeneity was moderate for sensitivity (I 2 = 61.8%) and substantial for specificity (I 2 = 90.6%).
No significant publication bias was detected ( p = 0.846).
Transcranial motor evoked potential monitoring in ossification of the posterior longitudinal ligament decompression yields pooled sensitivity 54.8%, specificity 90.0%, diagnostic odds ratio 13.75 (I 2 = 0%), and LR+ 5.47.
Level-specific alarm thresholds, multimodal monitoring, and standardised reporting are prerequisites for reliable clinical implementation.
SIGNIFICANCE: This is the first meta-analysis of transcranial motor evoked potential diagnostic accuracy in ossification of the posterior longitudinal ligament-exclusive surgical populations.