Evidence map›Paper›PMID 42414665›Full record

SynthesisEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

Intraoperative neuromonitoring in degenerative cervical myelopathy surgery: a systematic review and meta-analysis of diagnostic accuracy and postoperative neurological outcomes.

Mohammad Mahdi Aghaei, Armin Babaie, Sadegh Bagherzadeh, Abolfazl Paeenmahali, Faramarz Roohollahi, Mark Greenberg, Jay Kumar, Patrick Kim, Mohsen Rostami, Puya Alikhani

Abstract readSystematic ReviewMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Mohammad Mahdi AghaeiTehran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
Armin BabaieTehran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
Sadegh BagherzadehDepartment of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
Abolfazl PaeenmahaliDepartment of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of.
Faramarz RoohollahiDepartment of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran, Islamic Republic of. faramarzroohollahi@yahoo.com.
Mark GreenbergDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.
Jay KumarDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.
Patrick KimDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.
Mohsen RostamiDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA. mohsenrostami@usf.edu.
Puya AlikhaniDepartment of Neurosurgery, Brain and Spine, University of South Florida, Tampa, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesDegenerative cervical myelopathy (DCM) often requires surgical decompression but carries a risk of intraoperative neural injury. Intraoperative neurophysiological monitoring (IONM) is widely used to detect impending spinal cord compromise during such surgery, yet its impact on postoperative neurological outcomes remains debated. This systematic review and meta-analysis evaluated (1) the diagnostic accuracy of IONM modalities - somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), and multimodal monitoring - and (2) the effect of IONM versus no IONM on postoperative neurological outcomes in DCM.

methodsConducted under PRISMA and PRISMA-DTA guidelines (PROSPERO: CRD420251133125), we systematically searched PubMed, Embase, Scopus, and the Cochrane Library through August 2025. Eligible studies involved adult DCM surgery with IONM. Two meta-analyses were performed: a diagnostic test accuracy meta-analysis (pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) for SSEP, MEP, and multimodal IONM), and a comparative meta-analysis (pooled risk ratios (RR) of new or worsened postoperative neurological deficits with vs. without IONM).

resultsForty-four studies (N = 154,972 patients) were included. SSEP had low pooled sensitivity (~ 33%) but high specificity (~ 99%) (DOR ~ 34, AUC 0.79); MEP showed moderate sensitivity (~ 61%) with high specificity (~ 95%) (DOR ~ 38, AUC 0.91). Multimodal IONM achieved higher sensitivity (~ 76%) with similarly high specificity (~ 94%) (DOR ~ 70, AUC 0.91). Five comparative studies found no significant reduction in postoperative neurological deficits with IONM (pooled RR ≈ 0.6, p = 0.23).

conclusionMultimodal IONM demonstrates high diagnostic accuracy for detecting intraoperative neural injury in DCM surgery. However, its routine use did not significantly reduce postoperative neurological complication rates in this analysis, a finding that may partly reflect the limited number of comparative studies and the low absolute event rates. Our findings suggest that multimodal IONM should be considered most valuable for high-risk DCM patients and in complex procedures, where early detection of signal changes may alter surgical strategy.

Indexed as

Cervical VertebraeDecompression, SurgicalIntraoperative Neurophysiological MonitoringSpinal Cord DiseasesEvoked Potentials, MotorEvoked Potentials, SomatosensoryHumansDegenerative cervical myelopathyIntraoperative neuromonitoringIntraoperative neurophysiological monitoringMotor evoked potentialsSensitivitySomatosensory evoked potentialsSpecificity

Identifiers

PMID42414665

What Socratic holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.