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Purpose <p>False-positive transcranial motor-evoked potential (tcMEP) alerts during pediatric spinal deformity surgery can delay or alter surgical management. This cohort study evaluated anesthetic and physiologic predictors of false-positive alerts under standardized total intravenous anesthesia (TIVA).</p> Methods <p>All pediatric spine deformity surgeries with intraoperative tcMEP alerts (June–November 2024) at a single tertiary center were identified from a quality registry. Alerts were classified as false positive (FP), true positive (TP), or true negative (TN) by intraoperative assessment and postoperative outcomes. Standardized total intravenous anesthesia with bispectral index (BIS) and electroencephalography (EEG) monitoring was used. Physiologic and anesthetic variables were retrospectively extracted and compared using appropriate parametric and nonparametric tests (<i>p</i> &lt; 0.05).</p> Results <p>Of 99 patients during the study period, 15 experienced tcMEP alerts, yielding 631 timepoints: 80 FP, 13 TP, and 538 TN. BIS values were significantly lower during FP alerts (28.8 ± 14.5) than TP (53.6 ± 9.9) or TN (40.1 ± 12.9) (<i>p</i> &lt; 0.001). EEG suppression occurred in 36.4% of FP timepoints but in 0% of TP and 0.9% of TN events (<i>p</i> &lt; 0.001). Receiver operating characteristic (ROC) analysis showed that BIS had outstanding discrimination between false-positive and true-positive alerts (AUC 0.924, 95% CI: 0.823–1.00).</p> Conclusion <p>Periods of BIS suppression, in the setting of stable hemodynamics and anesthetic delivery, strongly correlate with false-positive tcMEP alerts. Incorporating BIS into intraoperative decision-making may help distinguish false positives from true neurologic injury, reducing unnecessary interruptions in pediatric spinal deformity surgery.</p>

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Physiologic and anesthetic predictors of false-positive motor-evoked potential alerts during pediatric spine surgery

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月15日

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  • Alex La Poche,
  • Austin Montgomery,
  • John Sestito,
  • James Hutchinson,
  • Thomas Romanelli,
  • Andrew Franklin,
  • Jeffrey Martus,
  • Gregory Mencio,
  • Craig Louer

摘要

Purpose

False-positive transcranial motor-evoked potential (tcMEP) alerts during pediatric spinal deformity surgery can delay or alter surgical management. This cohort study evaluated anesthetic and physiologic predictors of false-positive alerts under standardized total intravenous anesthesia (TIVA).

Methods

All pediatric spine deformity surgeries with intraoperative tcMEP alerts (June–November 2024) at a single tertiary center were identified from a quality registry. Alerts were classified as false positive (FP), true positive (TP), or true negative (TN) by intraoperative assessment and postoperative outcomes. Standardized total intravenous anesthesia with bispectral index (BIS) and electroencephalography (EEG) monitoring was used. Physiologic and anesthetic variables were retrospectively extracted and compared using appropriate parametric and nonparametric tests (p < 0.05).

Results

Of 99 patients during the study period, 15 experienced tcMEP alerts, yielding 631 timepoints: 80 FP, 13 TP, and 538 TN. BIS values were significantly lower during FP alerts (28.8 ± 14.5) than TP (53.6 ± 9.9) or TN (40.1 ± 12.9) (p < 0.001). EEG suppression occurred in 36.4% of FP timepoints but in 0% of TP and 0.9% of TN events (p < 0.001). Receiver operating characteristic (ROC) analysis showed that BIS had outstanding discrimination between false-positive and true-positive alerts (AUC 0.924, 95% CI: 0.823–1.00).

Conclusion

Periods of BIS suppression, in the setting of stable hemodynamics and anesthetic delivery, strongly correlate with false-positive tcMEP alerts. Incorporating BIS into intraoperative decision-making may help distinguish false positives from true neurologic injury, reducing unnecessary interruptions in pediatric spinal deformity surgery.