Utility of Pre-flip Intraoperative Neurophysiologic Monitoring Baselines for Posterior Decompression and Fusion for Cervical Spondylotic Myelopathy

Sunday, May 5, 2024

2:52 PM – 2:57 PM CT

Location: N427bc

Presenting Author(s)

Nora Kim, MD

Resident
NYU
New York, NY, US

Co-Author(s)

ZB

Zoran Budimlija, Dr. Med, PhD

Researcher
NYU Langone, United States
AF

Austin Feng, MD

Neurosugery Resident, PGY2
NYU Langone
New York, New York, United States
Darryl Lau, MD

Neurosurgeon, Director of Spinal Neurosurgery Research
NYU Langone
New York, NY, US
CL

Christopher Livia, MD/PhD

Resident Physician
NYU Langone
New York, New York, United States
TP

Themistocles Protopsaltis, MD

Faculty
NYU Langone, United States
KS

Karl Sangwon, n/a

Medical Student
NYU Langone Health
New York, New York, United States

Disclosure(s):

Nora Kim, MD: No financial relationships to disclose

Introduction: Intraoperative neurophysiologic monitoring (IONM) is crucial in spinal surgery for safeguarding the spinal cord. Despite its widespread use, the specific benefits of pre-flip baselines in posterior cervical decompression for central stenosis are unclear. Our study evaluates the effect of pre-flip baselines on surgical approach adaptations and neurological outcomes post-cervical spondylotic myelopathy (CSM) surgery.

Methods: We conducted a retrospective analysis on adults who underwent posterior cervical decompression and fusion for CSM from 2012-2022. Medical records and neurophysiological data were independently assessed. We compared perioperative, 2-week, and 3-month neurological outcomes between groups with and without pre-flip baselines.

Results: Of 169 patients (mean age 65.5, 61% female), 97 had no pre-flip, and 72 had pre-flip baselines. Preoperative weakness (50.9%) and T2 signal changes (73.7%) were similar across groups. The pre-flip group experienced longer preparation times (22.1 additional minutes, p=0.040, p=0.001). Neurological deficit rates were comparable at all points: perioperative (15.5% no pre-flip vs. 8.3% pre-flip, p=0.228), 2-week (4.1% vs. 5.6%, p=0.793), and 3-month (5.2% vs. 4.2%, p=0.999). Subgroup analyses within the pre-flip group revealed no significant differences in neurological deficits across different IONM signal scenarios post-flip.

Conclusion : Obtaining pre-flip baselines is based on individual surgeon preference and does not conclusively benefit neurological outcomes in CSM surgery. Our findings highlight the need for larger, prospective studies to further clarify the role of pre-flip baselines.