Intraoperative Multimodality Monitoring in Adult Spinal Deformity
Bibliographic record
Abstract
STUDY DESIGN: A retrospective analysis of prospectively collected data of 102 consecutive adult patients who underwent intraoperative neurophysiological monitoring (IOM) during spinal deformity corrective surgery. OBJECTIVE: To report the sensitivity and specificity of combined IOM in this study population using the postoperative neurologic examination as the "gold standard." SUMMARY OF BACKGROUND DATA: IOM is recommended during corrective spinal surgery and has been widely used in the pediatric deformity population. However, there are limited data describing the application of IOM in adults undergoing spinal deformity corrective surgery. METHODS: The study group consisted of 102 patients undergoing spinal deformity corrective surgery between 2001 and 2004. Patients were monitored using at least 2 or more electrophysiological methods including somatosensory-evoked potentials (SSEP), motor-evoked potentials (MEP), and electromyography (EMG). RESULTS: The mean age of patients was 41.5 years (+/-17). The majority of the operative procedures involved instrumented fusion from thoracic to lumbar/sacral spine (n = 55), thoracic-pelvis fusion (n = 26), and a combined total of 32 osteotomies (including 25 pedicle subtraction osteotomies and 7 Smith-Peterson osteotomies). SSEPs were recorded successfully in 101 (99%), EMGs in 89 of 102 (87%), and MEPs in 12 of 16 (75%). Five cases were true positives (4.95%), and these were all detected by combined monitoring (2-SSEP, 2-EMG, 1-MEP). There were no false positives with SSEPs, but EMG resulted in 30 of 89 (34%) false positives. There were 4 false negatives with SSEPs, which reduced its sensitivity to 33%. There was 1 false negative with EMG, and 0 with MEPs. When these results were collated, the overall sensitivity of combined multimodality IOM in this adult deformity series was 100%, specificity 84.3%, PPV 13.9%, and NPV 97%. The combined sensitivity in the osteotomy group (n = 32) was 67%, specificity 98%, PPV 80%, and NPV 96%. In comparison, there were no IOM abnormalities in those patients who had in situ/minor corrective procedures (n = 18; largely adult degenerative scoliosis). CONCLUSION: Multimodality IOM of spinal cord sensory and motor function during surgical correction of adult spinal deformity is feasible and provides useful neurophysiological data with an overall sensitivity of 100% and a specificity of 84.3% (67% and 98%, respectively in patients undergoing major deformity correction).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 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) | 0.001 | 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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".