ArticleSpine deformity2026
Physiologic and anesthetic predictors of false-positive motor-evoked potential alerts during pediatric spine surgery.
Article in Spine deformity, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeFalse-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).
methodsAll 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).
resultsOf 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).
conclusionPeriods 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.
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