{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T21:24:28Z","timestamp":1794000268873,"version":"4.8.0"},"reference-count":38,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Clinical Neurophysiology"],"published-print":{"date-parts":[[2026,10]]},"DOI":"10.1016\/j.clinph.2026.2111970","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T15:32:12Z","timestamp":1781105532000},"page":"2111970","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["The impact of neck extension on intraoperative neuromonitoring alerts in cervical myelopathy: A neurophysiological analysis"],"prefix":"10.1016","volume":"190","author":[{"given":"Omar","family":"Lubbad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry","family":"Spence","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paarth","family":"Sinha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8706-3172","authenticated-orcid":false,"given":"Josephine","family":"Poole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaarthigan","family":"Masilamany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8097-9240","authenticated-orcid":false,"given":"Rafiq","family":"Sheikhali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubeen","family":"Ahmad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Lambros","family":"Morassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nektarios K.","family":"Mazarakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.clinph.2026.2111970_b0005","doi-asserted-by":"crossref","unstructured":"Ajiboye RM, Zoller SD, Sharma A, Mosich GM, Drysch A, Li J, et al. Intraoperative neuromonitoring for anterior cervical spine surgery: what is the evidence? Spine (Phila Pa 1976). 2017;42(6):385-93. Doi: 10.1097\/BRS.0000000000001767.","DOI":"10.1097\/BRS.0000000000001767"},{"issue":"3 Suppl","key":"10.1016\/j.clinph.2026.2111970_b0010","first-page":"105S","article-title":"Accuracy of intraoperative neuromonitoring in the diagnosis of intraoperative neurological decline in the setting of spinal surgery: a systematic review and meta-analysis","volume":"14","author":"Alvi","year":"2024","journal-title":"Global Spine J."},{"issue":"1","key":"10.1016\/j.clinph.2026.2111970_b0015","doi-asserted-by":"crossref","first-page":"265","DOI":"10.3390\/jcm15010265","article-title":"Dynamic MRI in degenerative cervical myelopathy: a systematic review of radiological markers, correlations, and outcomes","volume":"15","author":"Baram","year":"2025","journal-title":"J. Clin. Med."},{"issue":"1","key":"10.1016\/j.clinph.2026.2111970_b0020","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4103\/isj.isj_64_22","article-title":"Intraoperative neuromonitoring in spine surgery: does it reduce neural complications? current evidence","volume":"6","author":"Basu","year":"2023","journal-title":"Indian Spine J."},{"key":"10.1016\/j.clinph.2026.2111970_b0025","unstructured":"Clark AJ, Safaee M, Chou D, et al. Comparative sensitivity of intraoperative motor evoked potential monitoring in predicting postoperative neurologic deficits: nondegenerative versus degenerative myelopathy. Spine (Phila Pa 1976). 2016;41(23):E1327-E1334."},{"key":"10.1016\/j.clinph.2026.2111970_b0030","doi-asserted-by":"crossref","unstructured":"Daniel JW, Botelho RV, Milano JB, Dantas FR, Onishi FJ, Neto ER, et al. Intraoperative neurophysiological monitoring in spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2018;43(16):1154-60. Doi: 10.1097\/BRS.0000000000002575.","DOI":"10.1097\/BRS.0000000000002575"},{"issue":"6","key":"10.1016\/j.clinph.2026.2111970_b0145","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1016\/j.clinph.2014.09.020","article-title":"Role of multimodal intraoperative neurophysiological monitoring during positioning of patient prior to cervical spine surgery","volume":"126","author":"Bello","year":"2015","journal-title":"Clin. Neurophysiol."},{"key":"10.1016\/j.clinph.2026.2111970_b0035","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s10195-019-0524-4","article-title":"Should evoked potential monitoring be used in degenerative cervical spine surgery?","volume":"20","author":"Di Martino","year":"2019","journal-title":"A systematic review. J Orthop Traumatol."},{"issue":"1","key":"10.1016\/j.clinph.2026.2111970_b0040","doi-asserted-by":"crossref","first-page":"20","DOI":"10.5312\/wjo.v7.i1.20","article-title":"Mechanical and cellular processes driving cervical myelopathy","volume":"7","author":"Dolan","year":"2016","journal-title":"World J. Orthop."},{"issue":"4","key":"10.1016\/j.clinph.2026.2111970_b0045","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/2009.8.FOCUS09150","article-title":"Intraoperative neurophysiological monitoring during spine surgery: a review","volume":"27","author":"Gonzalez","year":"2009","journal-title":"Neurosurg. Focus"},{"issue":"3","key":"10.1016\/j.clinph.2026.2111970_b0050","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/01.bsd.0000190816.28682.83","article-title":"Dynamic canal encroachment of ligamentum flavum: an in vitro study of cadaveric specimens","volume":"19","author":"Gu","year":"2006","journal-title":"J. Spinal Disord. Tech."},{"key":"10.1016\/j.clinph.2026.2111970_b0055","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000030841","article-title":"Retrospective observational study of the effects of residual neuromuscular blockade and sugammadex on motor-evoked potential monitoring during spine surgery in Japan","volume":"101","author":"Hayashi","year":"2022","journal-title":"Medicine (Baltimore)"},{"issue":"2","key":"10.1016\/j.clinph.2026.2111970_b0060","doi-asserted-by":"crossref","first-page":"208","DOI":"10.14444\/8205","article-title":"Estimating intraoperative neurophysiological monitoring rates for anterior cervical discectomy and fusion: are diagnostic or procedural codes accurate?","volume":"16","author":"Hobson","year":"2022","journal-title":"Int J Spine Surg."},{"issue":"3","key":"10.1016\/j.clinph.2026.2111970_b0065","doi-asserted-by":"crossref","first-page":"448","DOI":"10.14245\/ns.1938020.101","article-title":"Dynamic cord compression causing cervical myelopathy","volume":"16","author":"Joaquim","year":"2019","journal-title":"Neurospine"},{"issue":"2","key":"10.1016\/j.clinph.2026.2111970_b0070","doi-asserted-by":"crossref","first-page":"300","DOI":"10.14444\/8221","article-title":"Ligamentum flavum buckling vs hypertrophy in cervical myelopathy using dynamic imaging","volume":"16","author":"Kalidindi","year":"2022","journal-title":"Int J Spine Surg."},{"issue":"4","key":"10.1016\/j.clinph.2026.2111970_b0075","doi-asserted-by":"crossref","first-page":"425","DOI":"10.5312\/wjo.v5.i4.425","article-title":"Positioning patients for spine surgery: avoiding uncommon position-related complications","volume":"5","author":"Kamel","year":"2014","journal-title":"World J. Orthop."},{"issue":"1","key":"10.1016\/j.clinph.2026.2111970_b0080","doi-asserted-by":"crossref","first-page":"38","DOI":"10.3988\/jcn.2017.13.1.38","article-title":"Intraoperative motor-evoked potential disappearance versus amplitude-decrement alarm criteria during cervical spinal surgery: a long-term prognosis","volume":"13","author":"Kim","year":"2017","journal-title":"J Clin Neurol."},{"key":"10.1016\/j.clinph.2026.2111970_b0085","doi-asserted-by":"crossref","unstructured":"Kitagawa H, Itoh T, Takano H, et al. Motor evoked potential monitoring during upper cervical spine surgery. Spine (Phila Pa 1976). 1989;14(10):1078-83. Doi: 10.1097\/00007632-198910000-00009.","DOI":"10.1097\/00007632-198910000-00009"},{"issue":"1","key":"10.1016\/j.clinph.2026.2111970_b0090","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1186\/s13018-023-03745-1","article-title":"Dynamic evaluation of the cervical spine by kinematic MRI in patients with cervical spinal cord injury without fracture and dislocation","volume":"18","author":"Liu","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"10.1016\/j.clinph.2026.2111970_b0095","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.clinph.2018.10.008","article-title":"Recommendations of the International Society of Intraoperative Neurophysiology for intraoperative somatosensory evoked potentials","volume":"130","author":"MacDonald","year":"2019","journal-title":"Clin. Neurophysiol."},{"key":"10.1016\/j.clinph.2026.2111970_b0100","doi-asserted-by":"crossref","first-page":"2291","DOI":"10.1016\/j.clinph.2013.07.025","article-title":"American Society of Neurophysiological Monitoring. Intraoperative motor evoked potential monitoring - a position statement by the American Society of Neurophysiological Monitoring","volume":"124","author":"Macdonald","year":"2013","journal-title":"Clin. Neurophysiol."},{"key":"10.1016\/j.clinph.2026.2111970_b0105","article-title":"The value of dynamic MRI in cervical spondylotic myelopathy: about 24 cases","volume":"83","author":"Makhchoune","year":"2022","journal-title":"Ann Med Surg (Lond)."},{"key":"10.1016\/j.clinph.2026.2111970_b0110","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1097\/ANA.0b013e31824da7e5","article-title":"Awake fiberoptic intubation and self-positioning in patients at risk of secondary cervical injury: a pilot study","volume":"24","author":"Malcharek","year":"2012","journal-title":"J. Neurosurg. Anesthesiol."},{"issue":"2","key":"10.1016\/j.clinph.2026.2111970_b0115","doi-asserted-by":"crossref","first-page":"227","DOI":"10.31616\/asj.2023.0262","article-title":"Dynamic cervical spinal canal stenosis: identifying imaging risk factors in extended positions","volume":"18","author":"Matsumoto","year":"2024","journal-title":"Asian Spine J."},{"key":"10.1016\/j.clinph.2026.2111970_b0120","doi-asserted-by":"crossref","unstructured":"Morris SH, Howard JJ, El-Hawary R. Comparison of motor-evoked potentials versus somatosensory-evoked potentials as early indicators of neural compromise in rat model of spinal cord compression. Spine (Phila Pa 1976). 2017;42(6):E326-31. Doi: 10.1097\/BRS.0000000000001838.","DOI":"10.1097\/BRS.0000000000001838"},{"issue":"5","key":"10.1016\/j.clinph.2026.2111970_b0125","doi-asserted-by":"crossref","first-page":"647","DOI":"10.31616\/asj.2024.0176","article-title":"Utility of cervical dynamic magnetic resonance imaging for evaluating patients with cervical myelopathy: a retrospective study","volume":"18","author":"Narvekar","year":"2024","journal-title":"Asian Spine J."},{"issue":"10","key":"10.1016\/j.clinph.2026.2111970_b0130","doi-asserted-by":"crossref","first-page":"2595","DOI":"10.1007\/s00701-022-05354-z","article-title":"Intramedullary spinal cord cavernous malformations-association between intraoperative neurophysiological monitoring changes and neurological outcome","volume":"164","author":"Niedermeyer","year":"2022","journal-title":"Acta Neurochir. (Wien)"},{"key":"10.1016\/j.clinph.2026.2111970_b0135","doi-asserted-by":"crossref","unstructured":"Park D, Kim BH, Cho JM, et al. Diagnostic role of flexion-extension central motor conduction time in cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2020;46(22):1564-71. Doi: 10.1097\/BRS.0000000000003706.","DOI":"10.1097\/BRS.0000000000003706"},{"issue":"9","key":"10.1016\/j.clinph.2026.2111970_b0140","doi-asserted-by":"crossref","first-page":"765","DOI":"10.12998\/wjcc.v3.i9.765","article-title":"Intraoperative neurophysiological monitoring in spinal surgery","volume":"3","author":"Park","year":"2015","journal-title":"World J. Clin. Cases"},{"issue":"5","key":"10.1016\/j.clinph.2026.2111970_b0150","doi-asserted-by":"crossref","first-page":"E283","DOI":"10.1097\/BSD.0000000000001723","article-title":"The prevalence of intraoperative neuromonitoring in anterior cervical discectomy and fusion: trends, variances, and value appraisal","volume":"38","author":"Rowe","year":"2025","journal-title":"Clin Spine Surg."},{"key":"10.1016\/j.clinph.2026.2111970_b0155","doi-asserted-by":"crossref","DOI":"10.1097\/BSD.0000000000001911","article-title":"The use of intraoperative neuromonitoring in anterior cervical spine procedures for myelopathy: alert incidence, interventions, and prognostic value","author":"Rucker","year":"2025","journal-title":"Clin Spine Surg."},{"key":"10.1016\/j.clinph.2026.2111970_b0160","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/ACO.0000000000001044","article-title":"Anesthesia and intraoperative neurophysiological spinal cord monitoring","volume":"34","author":"Sahinovic","year":"2021","journal-title":"Curr Opin Anesthesiol."},{"issue":"11","key":"10.1016\/j.clinph.2026.2111970_b0165","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1016\/j.spinee.2017.05.020","article-title":"Perioperative neurologic complications during spinal fusion surgery: incidence and trends","volume":"17","author":"Thirumala","year":"2017","journal-title":"Spine J."},{"key":"10.1016\/j.clinph.2026.2111970_b0170","doi-asserted-by":"crossref","first-page":"219","DOI":"10.4103\/1658-354X.203024","article-title":"Sugammadex to reverse neuromuscular blockade and provide optimal conditions for motor-evoked potential monitoring","volume":"11","author":"Trifa","year":"2017","journal-title":"Saudi J Anaesth"},{"issue":"14","key":"10.1016\/j.clinph.2026.2111970_b0175","doi-asserted-by":"crossref","first-page":"4652","DOI":"10.3390\/jcm12144652","article-title":"The use of intraoperative neuromonitoring for cervical spine surgery: indications, challenges, and advances","volume":"12","author":"Wilson","year":"2023","journal-title":"J. Clin. Med."},{"issue":"9","key":"10.1016\/j.clinph.2026.2111970_b0180","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1007\/s00586-017-5161-0","article-title":"Occipitocervical inclination: new radiographic parameter of neutral occipitocervical position","volume":"26","author":"Yoon","year":"2017","journal-title":"Eur. Spine J."},{"issue":"7","key":"10.1016\/j.clinph.2026.2111970_b0185","doi-asserted-by":"crossref","first-page":"768","DOI":"10.3390\/brainsci15070768","article-title":"Intraoperative neurophysiological monitoring in contemporary spinal surgery: a systematic review of clinical outcomes and cost-effectiveness","volume":"15","author":"Zanin","year":"2025","journal-title":"Brain Sci."},{"issue":"Suppl","key":"10.1016\/j.clinph.2026.2111970_b0190","doi-asserted-by":"crossref","first-page":"S263","DOI":"10.4103\/0028-3886.360905","article-title":"Value of evoked potential changes associated with neck extension prior to cervical spine surgery","volume":"70","author":"Zhao","year":"2022","journal-title":"Neurol. India"}],"container-title":["Clinical Neurophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1388245726004700?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S1388245726004700?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T20:28:32Z","timestamp":1793996912000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S1388245726004700"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":38,"alternative-id":["S1388245726004700"],"URL":"https:\/\/doi.org\/10.1016\/j.clinph.2026.2111970","relation":{},"ISSN":["1388-2457"],"issn-type":[{"value":"1388-2457","type":"print"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"The impact of neck extension on intraoperative neuromonitoring alerts in cervical myelopathy: A neurophysiological analysis","name":"articletitle","label":"Article Title"},{"value":"Clinical Neurophysiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.clinph.2026.2111970","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier B.V. on behalf of International Federation of Clinical Neurophysiology.","name":"copyright","label":"Copyright"}],"article-number":"2111970"}}