Systematic review of alarm criteria and reversibility in motor-evoked potentials during intramedullary spinal cord tumor resection
By Admin | October 07, 2025
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Highlights
- Complete motor evoked potential loss is most predictive of post-op deficits in intramedullary spinal cord tumor surgeries.
- The 50% amplitude loss as the threshold for muscle-motor evoked potential and D-wave reductions remains clinically relevant.
- Unlike reversible muscle-motor evoked potential changes, reversible D-wave changes are strongly linked to post-op deficits.
Abstract
Background/Objective
Myogenic motor-evoked potentials (myogenic MEPs) and Direct waves (D-waves) are essential for monitoring motor pathways during intramedullary spinal cord tumor (IMSCT) resections. However, the diagnostic accuracy of alarm criteria and the prognostic value of reversible versus irreversible changes remain unclear. This is the first study addressing this gap.
Methods
Following PRISMA-DTA guidelines, this review searched PubMed, MEDLINE, and OVID (1985–2024) for studies on intraoperative myogenic MEPs and/or D-waves with postoperative motor outcomes in IMSCT resections.
Results
Across 25 studies (1,060 patients), log DOR for complete myogenic MEP loss predicting postoperative motor deficits was 4.18 (95% CI: 2.63–5.73), and for incomplete loss was 2.46 (95% CI: 1.74–3.18). Irreversible reductions had a log DOR of 2.513 (95% CI: 1.197–3.829), reversible 0.528 (95% CI: −0.273–1.330). D-wave monitoring used 50% threshold consistently, reversible reductions tied to 75% deficit rate.
Conclusion/significance
Irreversible changes in myogenic MEPs and D-waves and reversible D-wave changes increased postoperative motor deficit risk, unlike reversible myogenic MEP changes. Additionally, both incomplete and complete myogenic MEP loss predict neurological deficits; however, complete loss is a stronger predictor than incomplete loss. These findings help neurophysiologists guide the surgical team in minimizing motor pathway injury while maximizing...(More)
For more info please read, Systematic review of alarm criteria and reversibility in motor-evoked potentials, by ScienceDirect
