الفهرس 
Criteria TranscranialOnly 14 pages are availabe for public view
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Abstract
Background: Spine Surgery is the definitive treatment and indication for many traumatic spine illnesses, as well as several pathologies and deformities. Surgery in such a vital organ, formed in its core of the neural pathway that controls the whole of the human body, must be as safe, and least risky as possible, so as to prevent injuries to the neural pathway, or the surrounding vessels, or vital organs. Such great importance of the spine and the spinal cord, has urged surgeons and researchers to create techniques through which spine surgeries are well monitored, and the efficacy and normal physiology is well assessed intraoperatively.
Objective: to conduct a systematic review and meta-analysis of what has been published of the studies using transcranial motor evoked potential for intraoperative neuromonitoring during spine surgeries. This is for acquiring the best criteria for transcranial motor evoked potential (TcMEP) utilization for intraoperative neuromonitoring, as well as identifying the most accurate alarm point for TcMEP during intraoperative neuromonitoring.
Patients and Methods: a comprehensive and detailed search of literature was conducted through the Pubmed, Google Scholar, and Research Gate databases including articles related to intraoperative neuromonitoring modalities and transcranial motor evoked potential alarm points and criteria. Searches were performed with a combination of MeSH (medical subject headings). Only Studies published in the English Language with no lower date limit were included. The following search string was used in all databases; (“Intraoperative Neuromonitoring” or “Transcranial Motor Evoked Potential”).
Results: In a prospective study conducted in 2018, performed on 2867 patients, using a 70 % decrease in amplitude of the TcMEP curve as an alarm point during high-risk spinal surgeries, the number of true positive to false positive cases was found to be 126/234, while the number of true negative cases to false negative cases was found to be 2362/9 cases in total. The study demonstrates the necessity of intraoperative neuromonitoring for high-risk spinal surgery. 136 cases in this study were identified as rescue cases, as intraoperative TcMEP alert occurred and intraoperative maneuverings were done to overcome those alerts, hence hindering occurrence of postoperative neural deficit.
Conclusion: As regards different TcMEP alarm point values, it has been concluded that an alarm point of 50-60% decrease in amplitude of TcMEP is a more sensitive alarm point, than a higher value alarm point of the same modality. An alarm point of >70% decrease in amplitude has a much less sensitivity value than lower alarm points, which in turn will result in a lot of missed adverse events, and a higher percentage of false negative values.