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Intraoperative electrophysiological monitoring in spine surgery.

Abstract：

STUDY DESIGN:Review of the literature with analysis of pooled data. OBJECTIVE:To assess common intraoperative neuromonitoring (IOM) changes that occur during the course of spinal surgery, potential causes of change, and determine appropriate responses. Further, there will be discussion of appropriate application of IOM, and medical legal aspects. The structured literature review will answer the following questions: What are the various IOM methods currently available for spinal surgery? What are the sensitivities and specificities of each modality for neural element injury? How are the changes in each modality best interpreted? What is the appropriate response to indicated changes? Recommendations will be made as to the interpretation and appropriate response to IOM changes. SUMMARY OF BACKGROUND DATA:Total number of abstracts identified and reviewed was 187. Full review was performed on 18 articles. METHODS:The MEDLINE database was queried using the search terms IOM, spinal surgery, SSEP, wake-up test, MEP, spontaneous and triggered electromyography alone and in various combinations. Abstracts were identified and reviewed. Individual case reports were excluded. Detailed information and data from appropriate articles were assessed and compiled. RESULTS:Ability to achieve IOM baseline data varied from 70% to 98% for somatosensory-evoked potentials (SSEP) and 66% to 100% for motor-evoked potentials (MEP) in absence of neural axis abnormality. Multimodality intraoperative neuromonitoring (MIOM) provided false negatives in 0% to 0.79% of cases, whereas isolated SSEP monitoring alone provided false negative in 0.063% to 2.7% of cases. MIOM provided false positive warning in 0.6% to 1.38% of cases. CONCLUSION:As spine surgery, and patient comorbidity, becomes increasingly complex, IOM permits more aggressive deformity correction and tumor resection. Combination of SSEP and MEP monitoring provides assessment of entire spinal cord functionality in real time. Spontaneous and triggered electromyography add assessment of nerve roots. The wake-up test can continue to serve as a supplement when needed. MIOM may prove useful in preservation of neurologic function where an alteration of approach is possible. IOM is a valuable tool for optimization of outcome in complex spinal surgery.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Malhotra NR,Shaffrey CI

doi

10.1097/BRS.0b013e3181f6f0d0

subject

Has Abstract

pub_date

2010-12-01 00:00:00

pages

2167-79

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-201012010-00003

journal_volume

pub_type

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Intraoperative electrophysiological monitoring in spine surgery.