Intraoperative neuromonitoring during surgery for lumbar stenosis

Skinner, Stanley A.; Guo, Lin

doi:10.1016/b978-0-12-819826-1.00005-3

Cited by 3 publications

(5 citation statements)

References 112 publications

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“…Our multivariable analysis showed similar results, that factors such as lumbar fusion surgery (odds ratio 2.57) and scoliosis (odds ratio 4.07) were significant predictors of neurological deficits. The use of IONM should be considered in spine surgery in which the spinal cord or nerve roots are deemed to be at risk, including procedures involving deformity correction and procedures that require instrumentation 20,29,30 …”

Section: Discussionmentioning

confidence: 99%

“…The use of IONM should be considered in spine surgery in which the spinal cord or nerve roots are deemed to be at risk, including procedures involving deformity correction and procedures that require instrumentation. 20,29,30 There are several studies that question routine IONM use for all surgical procedures. 11,25,29,31 One study investigating 91 patients who underwent single-level lumbar discectomy reported that significant increases in operating room time (174 min with IONM vs. 144 min without IONM) and overall operative costs ($21,949 with IONM vs. $18,064 without IONM) were seen in the IONM group with no difference in neurological deficits.…”

Section: Epidemiologymentioning

confidence: 99%

“…[14][15][16] Nowadays, advanced technology such as fluoroscopic navigation, intraoperative 3D imaging, and robotics is providing safety and improvement in screw insertion accuracy and may reduce the risk of iatrogenic nerve injury. [17][18][19][20] Therefore, this study sought to elucidate trends in the utilization of IONM during elective lumbar surgery procedures by using The New York Department of Health's Statewide Planning and Research Cooperative System (SPARCS), investigate the association between IONM use and surgical outcomes such as intraoperative neurological injuries, and assess the necessity of the routine use of IONM in elective lumbar spine decompression and fusion surgery.…”

mentioning

confidence: 99%

“…Moreover, since the initial navigational technology was demonstrated in 1995, 13 the feasibility of the technology to improve the accuracy and efficiency of the lumbar pedicle screw insertion without the need for intraoperative imaging has been further demonstrated by several studies 14–16 . Nowadays, advanced technology such as fluoroscopic navigation, intraoperative 3D imaging, and robotics is providing safety and improvement in screw insertion accuracy and may reduce the risk of iatrogenic nerve injury 17–20 …”

mentioning

confidence: 99%

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The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

Dodo

Okano

Zelenty

et al. 2023

Spine

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Study Design. Retrospective database analysis. Objective. To elucidate trends in the utilization of intraoperative neurophysiological monitoring (IONM) during elective lumbar surgery procedures and to investigate the association between the use of IONM and surgical outcomes. Background. The routine use of IONM in elective lumbar spine procedures has recently been called into question due to longer operative time, higher cost, and other substitute advanced technologies. Methods. The Statewide Planning and Research Cooperative System database was accessed to perform this retrospective study. The trends of IONM use for lumbar decompression and fusion procedures were investigated from 2007 to 2018. The association between IONM use and surgical outcomes was investigated from 2017 to 2018. Multivariable logistic regression analyses, as well as propensity score matching (PS-matching), were conducted to assess IONM association in neurological deficits reduction. Results. The utilization of IONM showed an increase in a linear fashion from 79 cases in 2007 to 6201 cases in 2018. A total of 34,592 (12,419 monitored and 22,173 unmonitored) patients were extracted, and 210 patients (0.6%) were reported for postoperative neurological deficits. Unadjusted comparisons demonstrated that the IONM group was associated with significantly fewer neurological complications. However, the multivariable analysis indicated that IONM was not a significant predictor of neurological injuries. After the PS-matching of 23,642 patients, the incidence of neurological deficits was not significantly different between IONM and non-IONM patients. Conclusion. The utilization of IONM for elective lumbar surgeries continues to gain popularity. Our results indicated that IONM use was not associated with a reduction in neurological deficits and will not support the routine use of IONM for all elective lumbar surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

Dodo

Okano

Zelenty

et al. 2023

Spine

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“…During surgeries involving the spinal cord, which are considered from the occiput to the second lumbar vertebral body (L2), it is beneficial to use SSEP, MEP and EMG modalities to maximize the sensitivity and specificity of neurologic insult detection ( 36 - 38 ). Below L2, MEPs are seldom used as inadvertent compression or injury to the spinal cord is less likely, although this may no longer be supported by current literature in patients with known spinal stenosis at other levels ( 39 ). Additionally, since spinal roots exiting at L2 and below carry both sensory and motor fibers, MEP could be beneficial for more complete monitoring of peripheral nerve function ( 40 ).…”

Section: Traditional Ionm Applicationsmentioning

confidence: 99%

New frontiers in intraoperative neurophysiologic monitoring: a narrative review

Oliva,

Montejano,

Simmons

et al. 2023

Ann Transl Med

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Background and Objective Neurological insults during surgery arise from anatomic and/or physiologic perturbations. Intraoperative neurophysiologic monitoring (IONM) fills a critical role of ensuring that any neurological insults during certain surgical procedures are caught in real-time to prevent patient harm. IONM provides immediate feedback to the surgeon and anesthesiologist about the need for an intervention to prevent a neurologic deficit postoperatively. As important as it seems to have IONM available to any patient having surgery where a neurological injury is possible, the truth is that IONM is unavailable to large swaths of people around the world. This review is intended to bring attention to all of the ways IONM is critically important for a variety of surgeries and highlight the barriers preventing most patients around the world from benefiting from the technology. Expansion of IONM to benefit patients from all over the world is the new frontier. Methods We searched all English language original papers and reviews using Embase and MEDLINE/PubMed databases published from 1995 to 2022. Different combinations of the following search terms were used: intraoperative neuromonitoring, neurosurgery, low-income countries, cost, safety, and efficacy. Key Content and Findings We describe common IONM modalities used during surgery as well as explore barriers to implementation of IONM in resource-limited regions. Additionally, we describe ongoing efforts to establish IONM capabilities in new locations around the world. Conclusions In this paper, we performed a review of the literature on IONM with an emphasis on the basic understanding of clinical applications and the barriers for expansion into resource-limited settings. Finally, we provide our interpretation of “new frontiers” in IONM quite literally facilitating access to the tools and education so a hospital in Sub-Saharan Africa can incorporate IONM for their high-risk surgeries.

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Intraoperative Neurophysiological Monitoring in Neurosurgery

Guzzi,

Ricciuti,

Della Torre

et al. 2024

JCM

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Intraoperative neurophysiological monitoring (IONM) is a crucial advancement in neurosurgery, enhancing procedural safety and precision. This technique involves continuous real-time assessment of neurophysiological signals, aiding surgeons in timely interventions to protect neural structures. In addition to inherent limitations, IONM necessitates a detailed anesthetic plan for accurate signal recording. Given the growing importance of IONM in neurosurgery, we conducted a narrative review including the most relevant studies about the modalities and their application in different fields of neurosurgery. In particular, this review provides insights for all physicians and healthcare professionals unfamiliar with IONM, elucidating commonly used techniques in neurosurgery. In particular, it discusses the roles of IONM in various neurosurgical settings such as tumoral brain resection, neurovascular surgery, epilepsy surgery, spinal surgery, and peripheral nerve surgery. Furthermore, it offers an overview of the anesthesiologic strategies and limitations of techniques essential for the effective implementation of IONM.

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Intraoperative neuromonitoring during surgery for lumbar stenosis

Cited by 3 publications

References 112 publications

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

New frontiers in intraoperative neurophysiologic monitoring: a narrative review

Intraoperative Neurophysiological Monitoring in Neurosurgery

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