Value of multimodal neuroelectrophysiological monitoring during thoracic spinal stenosis surgery and impact of dural ossification

English Keywords:Thoracic spinal stenosis  Somatosensory evoked potentials  Motor evoked potentials  Thoracic spinal canal decompression,bone graft fusion, andinternal fixation  Intraoperative monitoring

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical values of somatosensory evoked potentials(SEPs) combined with motor evoked potentials(MEPs) during surgery for thoracic spinal stenosis(TSS), and to evaluate the effect ofdura ossification(DO) on the abnormalities of intraoperative neurophysiological monitoring(IONM). Methods: A retrospective analysis was conducted on 79 TSS patients who underwent thoracic spinal canal decompression, bone graft fusion, and internal fixation at our hospital from May 2024 to May 2025. SEPs and MEPs were monitored intraoperatively for all patients. The monitoring data of SEPs and MEPs during surgery were analyzed. Statistical analysis was performed on the occurrence rate, alarm rate, true and false positive rates, and true and false negative rates for single-mode SEPs, single-mode MEPs, and combined mode of SEPs-MEPs monitoring. Receiver operating characteristic(ROC) curves were used to evaluate the effectiveness of different monitoring modes. Additionally, the latency and amplitude differences between the affected and healthy sides in the DO group and the non-DO group were compared. Results: The occurrence rate for single-mode SEP monitoring was 82.3%(65/79) with an alarm rate of 6.2%(4/65); For single-mode MEPs monitoring, it was 72.2%(57/79) with an alarm rate of 8.8%(5/57); For combined mode, it was 86.1%(68/79) with an alarm rate of 4.4%(3/68). There were no statistically significant differences in occurrence rate, alarm rate, true and false positive rates, and true and false negative rates betweenthe three monitoring methods(P>0.05). The ROC curve showed that the area under the curve(AUC) for combined monitoring was 0.76, which was higher than that for single-mode SEPs(0.66) and single-mode MEPs(0.74). The sensitivity and specificity of combined monitoring were 83.3% and 75.3%, respectively. Compared with the non-DO group, there were no statistically significant differences in the amplitude of bilateral MEPs and SEPs in the DO group(P>0.05). However, the latency of bilateral MEPs and SEPs was significantly prolonged(P<0.05). Conclusions: The combined application of SEPs and MEPs monitoring can help to detect early nerve injury in TSS patients and reduce irreversible nerve damage during surgery. In TSS patients with DO, IONM shows a significantly prolonged latency of SEPs and MEPs.