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Objective:To discuss motor-evoked potential(MEP)monitoring of decompression in spinal surgeries, particularly surgeries for compressive spinal and radicular disorders, by using transcranial MEP. Methods:MEP monitoring after transcranial stimulation was performed during 148 spinal surgeries. MEP monitoring was performed using 200to 600-V transcranial stimulations, and electromyograms were recorded. MEP amplitudes were compensated by compound muscle action potential(CMAP)after peripheral nerve stimulation. Among 148 patients, 134 had no preoperative motor palsy and 122 had been operated on for the decompression of compressive spinal and radicular disorders. Results:In the 134 patients without preoperative motor palsy, the sensitivity of MEP monitoring in spinal surgery was 100% both with or without CMAP compensation, according to the criterion of 80% amplitude reduction as described by Langeloo, et al. The specificity in these 134 patients was 95.2% with CMAP compensation and 94.4% without CMAP compensation, according to the same criterion. In the 122 patients who underwent surgeries for spinal and radicular compressive disorders, the mean relative amplitude after CMAP compensation in the excellent(E)postoperative result group(recovery rate of Japan Orthopedic Association score more than 50%)was significantly higher than that in the other groups(p=0.0015). The number of patients in the E group whose relative amplitude index compensated by CMAP more than 1.0 was significantly higher than that less than 1.0(p=0.0003). All patients whose relative amplitude index with CMAP compensation was more than 1.2 achieved postoperative neurological recovery. Conclusion:Intraoperative MEP monitoring in spinal surgery was highly sensitive because none of the patients had false-negative results during more than 100 surgeries. If the relative amplitude index with CMAP compensation after peripheral nerve stimulation was more than 1.2, neurological recovery could certainly be expected. MEP in spinal surgery is very useful because of not only its high sensitivity and specificity but also the possibility for monitoring neurological recovery with CMAP compensation. (Received:August 31, 2011;accepted:February 16, 2012)

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Intraoperative Neurophysiological Monitoring of Decompression in Compressive Spinal and Radicular Disorders by using Motor-Evoked Potential after Transcranial Stimulation