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Predictive effects of different motor evoked potential warning thresholds on motor function recovery following decompression for cervical and thoracic ossification of the posterior longitudinal ligament
Received date: 2025-04-25
Online published: 2025-09-25
Objective To explore the optimal warning threshold of motor evoked potentials （MEP） in decompression surgery for ossification of the posterior longitudinal ligament （OPLL） at cervical and thoracic segments， and the predictive role of different MEP parameters on postoperative lower extremity motor function. Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital. There were 131 males and 96 females， with an average age of （60 ± 10） years. All patients underwent continuous neurophysiological monitoring during the operation， and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation （Dmax） and the ratio of MEP terminal amplitude change to the baseline at the end of the operation （Dend） were recorded. The correlations between these two ratios and the lower extremity motor function immediately after the operation and at 1 year were compared. According to the Medical Research Council muscle strength score （MRC） standard， a postoperative score increase of ≥1 point compared to preoperative was defined as postoperative motor dysfunction. Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year. Receiver operating characteristic （ROC） curves were drawn to predict postoperative lower extremity motor dysfunction using Dmax and Dend. Results Among the 227 patients， 186 had cervical OPLL and 41 had thoracic OPLL. The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases （3.76%） and 2 cases （1.08%） in the cervical group， and 9 cases （21.95%） and 3 cases （7.32%） in the thoracic group， respectively. The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group （P < 0.001）. The baseline induction rate of bilateral lower extremity MEPs was 98.92% （368/372） in the cervical group and 96.34% （79/82） in the thoracic group. The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax， and the differences were statistically significant （cervical group： r = 0.669， 0.517， P = 0.001 2； thoracic group： r = 0.882， 0.727， P = 0.003 6）， while the differences in the Pearson correlation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant （cervical group： r = 0.457， 0.352， P = 0.088； thoracic group： r = 0.760， 0.625， P = 0.098）. The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year， and the cut-off values of Dmax were 0.881 and 0.978， respectively. For the thoracic group， the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year， and the cut-off values of Dmax were 0.532 and 0.640， respectively. Conclusions In OPLL surgery， the MEP monitoring strategy should be adjusted according to the surgical segment. For the cervical segment， Dmax should be emphasized to balance high sensitivity and specificity， while for the thoracic segment， Dmax or Dend can be flexibly selected. Higher MEP warning thresholds are required for cervical OPLL surgery （Dmax： 0.881 immediately after the operation and 0.978 at 1 year； Dend： 0.853）， while significantly lower thresholds are needed for thoracic OPLL （Dmax/Dend： 0.532 immediately after the operation and 0.640 at 1 year）.
Li LI , Huan LI , Kai CHEN , Jia LIU , Wenwen SHEN , Yuqing WANG , Xiufang WU , Yushu BAI , Qiang LI , Jianmin LIU . Predictive effects of different motor evoked potential warning thresholds on motor function recovery following decompression for cervical and thoracic ossification of the posterior longitudinal ligament[J]. The Journal of Practical Medicine, 2025 , 41(18) : 2898 -2905 . DOI: 10.3969/j.issn.1006-5725.2025.18.017
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