Trial-to-trial latency variability of somatosensory evoked potentials as a prognostic indicator for surgical management of cervical spondylotic myelopathy

Hongyan Cui, Yazhou Wang, Xiang Li, Xiaobo Xie, Shengpu Xu, Yong Hu

Early detection of neural conductivity changes at the compressed spinal cord is important for predicting the surgical outcomes of patients with cervical spondylotic myelopathy (CSM). The prognostic value of median nerve somatosensory evoked potential (SEP) has been proposed previously. The present prospective study evaluates the use of trial-to-trial variability in SEP as a valuable predictor of neurological recovery after surgery of CSM. A total of 35 CSM patients who underwent surgery with up to 6-month follow-up were recruited in this study. SEP signals were recorded preoperatively. The single trial SEP was extracted by a newly developed second-order blind identification method. The postoperative recovery was assessed using the modified Japanese Orthopaedic Association. The correlation between the latency variability of trial-to-trial SEP and post-operative recovery ratio was analyzed. The prognostic value of trial-to-trial SEP for CSM was evaluated using a receiver operator characteristic curve which can accurately reflect the relationship between sensitivity and specificity of a diagnostic method and represent the accuracy of prognosis. The correlation coefficient of trial-to-trial latency variability and the 6-month recovery ratio was statistically significant (r = -0.82, P < 0.01). The trial-to-trial SEP had a higher prognostic accuracy (AUC = 0.928, P < 0.001) with an optimal prognostic value of 9.25 % compared with averaged SEP when the threshold of recovery ratio was 40 %, and was more sensitive (93.80 %) than the averaged SEP (43.80 %). These findings indicate that the latency variability of trial-to-trial SEP reflect the recovery ratio of CSM patients after surgery. It is suggested that the latency variability of trial-to-trial SEP is useful for predicting the surgical outcomes for patients with CSM, which would be a potential indication of surgical treatment for CSM to help decision making of surgical planning for CSM patients.