Intraoperative Neurophysiological Monitoring — FRCA Final MCQ

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ModerateNeuroanaesthesiaIntraoperative Neurophysiological MonitoringFRCA Final

A 55-year-old man with severe degenerative cervical myelopathy is undergoing multilevel anterior cervical discectomy and fusion. Intraoperative neurophysiological monitoring is requested to detect impending injury to the cervical spinal cord. Which monitoring modality is most appropriate?

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Correct answer: C — Combined SSEPs and MEPs

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · C = shown as D · A = shown as E

D is correct. SSEPs principally assess ascending dorsal-column sensory pathway integrity, whereas transcranial MEPs assess descending corticospinal motor pathways. Either modality used alone may miss an injury affecting the other functional system; multimodal SSEP–MEP monitoring therefore provides the most comprehensive assessment and has greater diagnostic sensitivity in cervical myelopathy surgery. EEG monitors cortical electrical activity rather than spinal cord tract integrity. EMG is useful mainly for detecting nerve-root irritation or injury and does not adequately monitor the long spinal cord tracts. MEPs are markedly attenuated by neuromuscular blockade, and both MEPs and SSEPs are suppressed by volatile anaesthetic agents; monitoring commonly therefore requires no further neuromuscular blocker after intubation and a stable, usually intravenous-dominant, anaesthetic technique.

Reference: Rostami M et al. Intraoperative neuromonitoring in degenerative cervical myelopathy surgery: a systematic review and meta-analysis of diagnostic accuracy and postoperative neurological outcomes. European Spine Journal. 2026. https://pubmed.ncbi.nlm.nih.gov/42414665/