BACKGROUND: Intraoperative neuromonitoring (IONM) has been reported to be sensitive and specific in the detection of neurological injury during spinal surgery. However, utilizing multimodality IONM to predict postoperative neural deficits following cervical laminoplasty remains unclear.OBJECTIVE: The purpose of this study is to clarify the incidence of C5 palsy utilizing multimodality IONM and to compare the accuracy of multimodality IONM to predict postoperative C5 palsy against isolated transcranial motor-evoked potential (MEP).

METHODS: We retrospectively reviewed 135 consecutive patients at a single institution with cervical spondylotic myelopathy (CSM) who underwent open door laminoplasty utilizing MEP combined with somatosensory-evoked potentials (SSEP) and free-running electromyography (EMG).

RESULTS: Multimodality IONM was obtained in 131 cases. Ossification of the posterior longitudinal ligament was present in 19 patients (14.1%). Postoperative C5 palsy occurred in 3 patients (2.2%). Significant MEP alerts occurred in 12 patients. Significant SSEP change was not observed in this study. To predict acute onset C5 palsy, MEP alerts in the deltoid or biceps had 100% sensitivity and 98.4% specificity. Transient or persistent MEP alerts in the deltoid or biceps have same positive predictive value with sensitivity of 50.0% and specificity 99.2%.

CONCLUSION: The incidence of any neurological deficit including C5 palsy during laminoplasty while utilizing multimodality IONM was relatively low. MEP alerts in the deltoids or biceps had 100% sensitivity and 98.4% specificity for predicting a postoperative deficit. SSEP did not appear to be helpful in predicting postoperative deficits.