Neurophysiological monitoring during anterior cervical discectomy and fusion for ossification of the posterior longitudinal ligament

Highlights • Postoperative neurological complications are not rare in ACDF for OPLL pathology. • Multimodal IONM may reduce neurological damage in ACDF surgery for OPLL. • IONM and preoperative myelopathy were associated with neurological complications.
Objective This study aimed to investigate the value of intraoperative neurophysiological monitoring (IONM) in anterior cervical spine discectomy with fusion (ACDF) for ossification of the posterior longitudinal ligament (OPLL). Methods Patients who underwent multimodal IONM (transcranial electrical motor-evoked potentials [tcMEP], somatosensory-evoked potentials, and continuous electromyography) for ACDF from 2009 to 2019 were compared to historical controls from 2003 to 2009. The rates of postoperative neurological deficits, neurophysiological warnings, and their characteristics were analyzed. Results Among 196 patients, postoperative neurological deficit rates were 3.79% and 14.06% in the IONM and historical control (non-IONM) groups, respectively (p