1Assistant Professor, Dept of Neurosurgery, Vydehi Institute of Medical Sciences and research centre, Bengaluru
2Senior consultant and HOD, department of Neurosurgery, Apollo Cancer Centre, Teynampet, Chennai.
3Assistant Professor, Dept of Anaesthesia, Sri Jayadeva institute of cardiovascular sciences, Mysore.
4Professor, Dept of Neurosurgery, Krishna Institute of Medical Sciences, Karad.
5Senior Resident, dept of Head and Neck Surgical Oncology, Malabar Cancer Centre, Thalassery.
Received: 16th Dec, 2025; Revised: 11th Feb 2026; Accepted: 13th Feb, 2026; Available Online: 28th Feb, 2026
Background: Despite advancement and refinement in neurosurgical operative techniques neurological impairment due to spinal cord surgery remained as high. Various studies incorporated numerous validated techniques for monitoring spinal cord and nerve root functions in spinal tumor (intramedullary, intradural extramedullary, extradural) surgery. Each monitoring techniques (MEP, SSEP, D-wave, EMG) having different sensitivity and specificity. Simultaneously use of Multiple monitoring techniques is advocated to increase the accuracy of IONM. Here we wanted to study the sensitivity and specificity of intraoperative MEP and SSEP in the surgery of spinal lesions and various factors affecting outcome of the surgery.
Aims and Objectives: To determine the Sensitivity, Specificity, Positive predictive value and Negative predictive value of Intraoperative electrophysiological monitoring of MEP and SSEP in spinal tumor surgery and to study the association of various factors in determining the outcome of the surgery.
Material and Methods: It is a prospective and observational study of patients undergoing surgery for spinal tumor at Apollo Specialty Hospital, Chennai. The duration of the study was from June 2016 to August 2020. Patient functional assessment was graded as per Modified McCormick scale. Tumor location, level and extent are determined from patients MRI spine image. A detailed clinical neurological examination is done and Patient's functional assessment was graded as per Modified McCormick scale at the time of discharge. Extent of resection was determined based on follow-up MRI scan.
Inclusion criteria: Patients undergoing Spinal tumor surgery with intraoperative Neuromonitoring of MEP and SSEP.
Exclusion criteria: 1) Patient age less than 10 years, 2) Patients with raised ICP, 3) Patients Undergoing spinal tumor surgery without intraoperative neuromonitoring.
Results: Sensitivity and Specificity of Intraoperative MEP change was 80% and 98% respectively. PPV and NPV of Intraoperative MEP change was 80% and 98% respectively. Sensitivity and Specificity of Intraoperative SSEP change was 80% and 96% respectively. PPV and NPV of Intraoperative SSEP change was 66.7% and 98% respectively. Sensitivity and Specificity of combined Intraoperative MEP and SSEP change was 100% and 94% respectively. PPV and NPV of combined Intraoperative MEP and SSEP change was 62.5% and 100% respectively.
Conclusion: Intraoperative Neuromonitoring is an essential tool in the spinal tumor surgery. IONM helps in identification and preservation of vital structures during surgery and better neurological outcome postoperatively. It gives confidence to the surgeon while operating, knowing the fact that neural structures are neuro-physiologically intact.
Keywords: IONM, MEP, SSEP
How to cite this article: Eshwarappa VS, Ghosh S, B PN, Srinivasalu S, Sundaresan D. Intraoperative Combined Electrophysiological Monitoring of Muscle Evoked Potentials and Somatosensory Evoked Potentials in Spinal Tumor Surgery and Its Post Operative Significance. Int J Drug Deliv Technol. 2026;16(3): 405-412. DOI: 10.25258/ijddt.16.3.46
Source of support: Nil.
Conflict of interest: None