Cervical myelopathy is a progressive condition caused by spinal cord compression, often requiring surgical intervention such as cervical lateral mass fusion. Intraoperative Motor Evoked Potential (MEP) monitoring plays a crucial role in preventing iatrogenic neurological damage during these surgeries. However, obtaining reliable baseline MEP signals remains a challenge due to the suppressive effects of anesthetic agents on motor pathways.

This Phase 4, prospective, randomized controlled trial aims to compare the efficacy of two anesthetic regimens—Dexmedetomidine-Ketamine vs. Propofol-Fentanyl—in optimizing MEP signal acquisition during cervical lateral mass fusion. The study will evaluate MEP amplitude changes, hemodynamic stability, and intraoperative patient movement as primary and secondary outcomes. Target-Controlled Infusion (TCI) pumps will be used to precisely titrate anesthetic agents, maintaining optimal conditions for neurophysiological monitoring.

A total of 76 patients with cervical myelopathy scheduled for surgery will be recruited and randomized into two groups. Intraoperative MEP signals will be recorded at predefined time points, and postoperative neurological function will be assessed using Nurick’s grading at six months.

This study aims to establish an optimal anesthetic protocol for neuromonitoring, potentially improving surgical outcomes and patient safety in cervical spine surgeries. The findings may guide future anesthetic practices in spine surgery and neurophysiology.