Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

Abstract

A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal-and cortical-evoked potentials, combined with continuous EMG-and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented truenegative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results.

Current opinions and recommendations on multimodal intraoperative monitoring during spine surgeries

“…The high sensitivity and specificity of MIOM during the different surgical procedures as presented in this supplement [10][11][12][28][29][30][31] document its advantages. It has been clearly shown that MEP monitoring improves outcome after surgery for intramedullary spinal tumors [27].…”

Assessment of outcome in patients undergoing surgery for intradural spinal tumor using the multidimensional patient-rated Core Outcome Measures Index and the modified McCormick Scale

“…Surgery was performed under general anesthesia using a laminoplasty approach in the prone position with multimodal intraoperative monitoring, as previously described. 2,21 Patients were transferred to the ward 24 hours after surgery. Mobilization under physiotherapeutic observation started 1-2 days after surgery.…”

Demographic Trends in the Use of Intraoperative Neuromonitoring for Scoliosis Surgery in the United States

“…19 Multimodal ION has resulted in increases in the sensitivity and specificity for neurologic injury to nearly 100%. [19][20][21][22] Neurologic injury within 30 days from the date of index surgery occurred in 1.8 and 2.0% of patients that underwent scoliosis surgery with and without ION, respectively. These rates are within the range of 0.5 to 3% risk of neurological injury reported in the literature for deformity surgeries.…”