For a study, the researchers sought to estimate the sensitivity and specificity of combined motor and sensory intraoperative neuromonitoring (IONM) for cervical spondylotic myelopathy (CSM). Patients were tested post-operatively to estimate the clinical occurrence of new neurologic deficit, which correlated with monitoring alerts recorded per established standard criteria. The overall incidence of positive IONM alerts was reported as 1.3% (N=7), all of which were motor alerts. All came out to be false positives as no patients were reported with clinical neurological deterioration post-operatively. The false-positive rate was found to be 1.4% (N=146) for anterior surgeries and 1.3% (N=394) for posteriors with no statistical difference between them (P=1.0, Fisher exact test). There were no false-negative alerts, and all negatives were true negatives (N=533). The overall sensitivity of detecting a new neurologic deficit was 0%, overall specificity was 98.7%. Combined motor and sensory neuromonitoring for CSM patients made a confusing choice between the motor or sensory information when in disagreement in 1.3% of surgical patients. Criterion standard clinical analysis confirmed all motor alerts were false positives. The surgical plan was found to be negatively altered by following false motor alerts early on but disregarded in later cases in favor of sensory information. Neuromonitoring added set-up time and cost, but without clear benefit in this series.
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