Transcranial motor-evoked potential alert status and 2-year neurological outcomes after postoperative neurological deficits in spinal deformity surgery.
Alert-negative postoperative deficits had worse 2-year neurological recovery than alert-positive cases
Transcranial motor-evoked potential alert status and 2-year neurological outcomes after postoperative neurological deficits in spinal deformity surgery.
To evaluate 2-year neurological outcomes after postoperative neurological deficits (postoperative neurological deficits) following spinal deformity surgery according to transcranial motor-evoked potential (transcranial motor-evoked potential) alert status, and to examine delayed transcranial motor-evoked potential deterioration during wound closure.
We retrospectively reviewed 1472 patients who underwent spinal deformity surgery with intraoperative neurophysiological monitoring.
over half of alert-negative deficits never recovered by 2 years
Postoperative neurological deficits occurred in 49/1472 patients (3.3%).
In the cohort excluding adult spinal deformity (non-ASD), residual deficits were confined to alert-negative cases (6/7 [85.7%] vs 0/14 [0.0%], p < 0.001).
In the exploratory cohort requiring temporary rod removal (n = 37), 13/37 transcranial motor-evoked potential alerts (35.1%) occurred during wound closure, at a median of 19 min after deformity correction.
Among patients with postoperative neurological deficits, those without intraoperative transcranial motor-evoked potential alerts had poorer 2-year outcomes, particularly in the non-ASD cohort.
Alert-negative events may reflect limited detection of isolated nerve root injuries, alert-threshold selection, or monitoring termination before evolving spinal cord compromise becomes detectable.
Continued transcranial motor-evoked potential monitoring through completion of skin closure may be considered in selected cases when delayed spinal cord compromise is suspected.