Strong work. This was a sad result. While you knew that we should generally get SSEPs as a first-line test in the absence of pupillary non-reactivity, you quickly recognized that this patient's cervical cord injury precluded SSEP testing for neuroprognostication purposes.
These strongest predictors have the most favorable false positive rates (not zero, of course), so we need to identify whether they hold for our patient first before moving on to the less reliable tests that have a greater degree of uncertainty. MRI, with its ability to identify diffusion restriction across cortex and deep gray matter, is only a moderate predictor.
The 2023 NCS guidelines do specifically call out that the presence of responses at Erb's point and the cervical spine are essential for reliable test performance and interpretation. However, it'd be best to simply avoid SSEPs when a cervical cord injury is known or suspected. In this case, you can safely move on to the next test (everyone's favorite): MRI brain, if possible.
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