Results of anterior cervical disc arthroplasty with intraoperative neurophysiological monitoring

Abstract

Overview

Anterior cervical disc arthroplasty (CDA) has been widely used for degenerative cervical spine conditions. This study aims to investigate the value of intraoperative neurophysiological monitoring (IONM) techniques and treatment outcomes in anterior cervical disc arthroplasty (CDA) for managing cervical spine degenerative diseases.

Methods

Patients undergoing anterior cervical disc arthroplasty from 2021 to 2023 were monitored using multi-modal IONM techniques: transcranial motor-evoked potentials (tcMEP), somatosensory evoked potentials (SSEP), and continuous raw electromyography (raw EMG). Postoperative neurological deficits, intraoperative neurophysiological warnings, and related characteristics were analyzed.

Results

Postoperative outcomes were favorable. The Visual Analog Scale (VAS) score decreased from 8.6 ± 1.1 to 2.6 ± 0.8, and the Neck Disability Index (NDI) score decreased from 50.3 ± 7.2 to 28.4 ± 6.2. The range of motion (ROM) remained unchanged significantly before and three months after surgery. Out of 215 patients, the postoperative neurological deficit rate was 0 %. A total of 55 warnings were observed in IONM (10 SSEP, 5 tcMEP, and 40 raw EMG). The negative predictive value of the three techniques was 100 %. The specificity of IONM warnings for detecting neurological complications were SSEP 95.3 %, MEP 97.7 %, and raw EMG 81.4 %.

Conclusion

Anterior cervical disc arthroplasty (CDA) can be effectively applied in clinical practice for treating degenerative cervical spine disorders. IONM, especially multi-modal IONM, can be a useful tool for detecting nerve damage during cervical disc replacement, particularly in high-risk cases.