Neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathy
Abstract Background Intraoperative neurophysiological monitoring (IONM) is a critical tool used during cervical spine surgeries to detect neurological deficits in real time, potentially preventing complications such as white cord syndrome (WCS). This study evaluates the effectiveness of IONM and ide...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2025-06-01
|
| Series: | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41983-025-00991-4 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850207269194563584 |
|---|---|
| author | Ahmed Hamdy Ashry Ayman Tarek Mahmoud Mohamed Adel Ghoneim |
| author_facet | Ahmed Hamdy Ashry Ayman Tarek Mahmoud Mohamed Adel Ghoneim |
| author_sort | Ahmed Hamdy Ashry |
| collection | DOAJ |
| description | Abstract Background Intraoperative neurophysiological monitoring (IONM) is a critical tool used during cervical spine surgeries to detect neurological deficits in real time, potentially preventing complications such as white cord syndrome (WCS). This study evaluates the effectiveness of IONM and identifies specific risk factors associated with the development of WCS. We conducted a retrospective analysis of 400 cases of cervical spondylotic myelopathy from 2017 to 2023. Patients were categorized into two groups based on whether IONM was utilized during surgery. Demographic, clinical, radiological, and surgical data were collected. The degree of myelopathy was assessed using the Modified Japanese Orthopedic Association (MJOA) scale. IONM employed both motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) for neurological function assessment. Results While IONM exhibited an 80% sensitivity in identifying WCS, its specificity was only 73%, indicating a significant rate of false positives. Additionally, several risk factors were identified, including comorbidities, such as diabetes and hypertension, symptoms duration exceeding 12 months, and the presence of hyperintense T2-weighted MRI signals. Despite the widespread use of IONM, there was no significant reduction in WCS incidence among patients monitored compared to those who were not. Conclusion This study underscores the importance of IONM in the early detection of WCS while highlighting its limitations in preventing the condition. Understanding the multifactorial risk factors for WCS can aid neurosurgeons in optimizing surgical strategies and improving patient outcomes. |
| format | Article |
| id | doaj-art-bbdb3bb0c0444f06a874fda97101707f |
| institution | OA Journals |
| issn | 1687-8329 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery |
| spelling | doaj-art-bbdb3bb0c0444f06a874fda97101707f2025-08-20T02:10:34ZengSpringerOpenThe Egyptian Journal of Neurology, Psychiatry and Neurosurgery1687-83292025-06-016111610.1186/s41983-025-00991-4Neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathyAhmed Hamdy Ashry0Ayman Tarek Mahmoud1Mohamed Adel Ghoneim2Department of Neurosurgery, Kasr Al Ainy School of Medicine, Cairo UniversityDepartment of Neurosurgery, Kasr Al Ainy School of Medicine, Cairo UniversityDepartment of Neurosurgery, Kasr Al Ainy School of Medicine, Cairo UniversityAbstract Background Intraoperative neurophysiological monitoring (IONM) is a critical tool used during cervical spine surgeries to detect neurological deficits in real time, potentially preventing complications such as white cord syndrome (WCS). This study evaluates the effectiveness of IONM and identifies specific risk factors associated with the development of WCS. We conducted a retrospective analysis of 400 cases of cervical spondylotic myelopathy from 2017 to 2023. Patients were categorized into two groups based on whether IONM was utilized during surgery. Demographic, clinical, radiological, and surgical data were collected. The degree of myelopathy was assessed using the Modified Japanese Orthopedic Association (MJOA) scale. IONM employed both motor-evoked potentials (MEPs) and somatosensory-evoked potentials (SSEPs) for neurological function assessment. Results While IONM exhibited an 80% sensitivity in identifying WCS, its specificity was only 73%, indicating a significant rate of false positives. Additionally, several risk factors were identified, including comorbidities, such as diabetes and hypertension, symptoms duration exceeding 12 months, and the presence of hyperintense T2-weighted MRI signals. Despite the widespread use of IONM, there was no significant reduction in WCS incidence among patients monitored compared to those who were not. Conclusion This study underscores the importance of IONM in the early detection of WCS while highlighting its limitations in preventing the condition. Understanding the multifactorial risk factors for WCS can aid neurosurgeons in optimizing surgical strategies and improving patient outcomes.https://doi.org/10.1186/s41983-025-00991-4WhiteCordCervicalMyelopathyElectrophysiologicalMonitoring |
| spellingShingle | Ahmed Hamdy Ashry Ayman Tarek Mahmoud Mohamed Adel Ghoneim Neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathy The Egyptian Journal of Neurology, Psychiatry and Neurosurgery White Cord Cervical Myelopathy Electrophysiological Monitoring |
| title | Neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathy |
| title_full | Neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathy |
| title_fullStr | Neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathy |
| title_full_unstemmed | Neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathy |
| title_short | Neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathy |
| title_sort | neurophysiological monitoring and risk factors for white cord syndrome in cervical spondylotic myelopathy |
| topic | White Cord Cervical Myelopathy Electrophysiological Monitoring |
| url | https://doi.org/10.1186/s41983-025-00991-4 |
| work_keys_str_mv | AT ahmedhamdyashry neurophysiologicalmonitoringandriskfactorsforwhitecordsyndromeincervicalspondyloticmyelopathy AT aymantarekmahmoud neurophysiologicalmonitoringandriskfactorsforwhitecordsyndromeincervicalspondyloticmyelopathy AT mohamedadelghoneim neurophysiologicalmonitoringandriskfactorsforwhitecordsyndromeincervicalspondyloticmyelopathy |