Multimodality Intraoperative Neurophysiologic Monitoring Findings During Surgery for Adult Tethered Cord Syndrome: Analysis of a Series of 44 Patients With Long-Term Follow-up
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Bibliographic record
Abstract
STUDY DESIGN: Prospective analysis of a consecutive series in which multimodality intraoperative neurophysiologic monitoring was used as an adjunct to microneurosurgery for adult tethered cord syndrome. The results of multimodality intraoperative neurophysiologic monitoring were compared with the "gold standard" (neurologic outcomes). OBJECTIVE: To assess the sensitivity, specificity, and positive and negative predictive values of multimodality intraoperative neurophysiologic monitoring in surgery for adult tethered cord syndrome. SUMMARY OF BACKGROUND DATA: Although intraoperative electrophysiologic techniques may help to minimize neural injury during spinal microneurosurgery, to our knowledge, no study has quantitatively evaluated the value of multimodality intraoperative neurophysiologic monitoring in the management of adult tethered cord syndrome. METHODS: Multimodality intraoperative neurophysiologic monitoring included posterior tibial nerve somatosensory evoked potentials (SSEPs), continuous electromyographic (EMG) monitoring of the L2 to S4 myotomes, and evoked EMG. Follow-up neurologic evaluations were performed for at least 1 year. RESULTS: A total of 44 consecutive patients, including 19 males and 25 females (aged 43 +/- 15 years), who underwent microsurgery for adult tethered cord syndrome were evaluated. After surgery, new neurologic deficits, including 1 transient and 1 permanent, developed in 2 patients. There was 1 patient who had persistent posterior tibial nerve SSEP amplitude reduction following microsurgical manipulation. In 1 patient, a transient posterior tibial nerve SSEP amplitude reduction prompted a change in microneurosurgical strategy. This patient awoke with no new postoperative neurologic deficits. For SSEPs, the sensitivity was 50% and specificity 100%. EMG bursts were recorded in 36 patients (82%). The 2 patients with postoperative neurologic worsening had EMG activity in the myotomes, where their new deficits presented. Continuous EMG had a sensitivity of 100% and a specificity of 19%. CONCLUSIONS: To our knowledge, this is the largest series to date reporting the use of multimodality intraoperative neurophysiologic monitoring in the surgical management of adult tethered cord syndrome. Posterior tibial nerve SSEPs have high specificity, but low sensitivity, for predicting new neurologic deficits. In contrast, continuous EMG showed high sensitivity and low specificity. Evoked EMG accurately identified functional neural tissue. The combined recording of SSEPs in concert with continuous and evoked EMGs may provide a useful adjunct to complex microsurgery for adult tethered cord syndrome.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it