Overview of Intraoperative Neurophysiological Monitoring During Spine Surgery

Shilian, Parastou; Zada, Gabriel; Kim, Aaron C.; Gonzalez, Andres A.

doi:10.1097/wnp.0000000000000132

Cited by 17 publications

(6 citation statements)

References 36 publications

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“…However, discharges can be seen with nerve stretch, blunt trauma, compression, or ischemia. High‐frequency or high‐amplitude responses suggest irritation to the nerve roots . After placing the needles or surface electrodes, the surgeon or his or her assistant performs a train‐of‐four twitch test to confirm that there are no long‐acting paralytics in the patient's circulatory system .…”

Section: Neuromonitoring and Anesthesiamentioning

confidence: 99%

Patient Care During Minimally Invasive Lateral Spine Surgery

Dufault¹

2018

AORN Journal

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Perioperative nurses care for patients undergoing a wide range of surgical procedures. One fast-growing surgical specialty is spine surgery performed using minimally invasive techniques. Patients may be candidates for minimally invasive spine surgery based on their presenting signs and symptoms and medical imaging test results. Open anterior and posterior surgical approaches to spine surgery are how surgeons traditionally have performed these procedures. However, new technology has enabled a minimally invasive lateral approach to the spine. This approach minimizes many of the risks and challenges associated with both the anterior and posterior approaches. Minimally invasive lateral interbody fusion requires the perioperative nurse to have a thorough understanding of the necessary patient positioning, spinal anatomy, and OR suite setup to ensure a safe and successful surgical experience for the patient.

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Section: Neuromonitoring and Anesthesiamentioning

confidence: 99%

Patient Care During Minimally Invasive Lateral Spine Surgery

Dufault¹

2018

AORN Journal

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“…Various neurophysiologic monitoring modalities have been utilized to monitor the spinal cord intraoperatively during corrective scoliosis surgery, including motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP). 3,4 Intraoperative monitoring and detection of alternations of the evoked potentials alerts the surgeon to possible neurological damage and the need for a corrective response to potentially reduce the risk of harm.…”

Section: Introductionmentioning

confidence: 99%

The effects of dexmedetomidine on intraoperative neurophysiologic monitoring modalities during corrective scoliosis surgery in pediatric patients: A systematic review

Abdelaal Ahmed Mahmoud Metwally Alkhatip,

Mills,

Hogue

et al. 2023

Pediatric Anesthesia

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BackgroundDuring scoliosis surgery, motor evoked potentials (MEP), and somatosensory evoked potentials (SSEP) have been reported to be affected by the use of higher doses of anesthetic agents. Dexmedetomidine, a sympatholytic agent, an alpha‐2 receptor agonist, has been used as an adjunctive agent to lower anesthetic dose. However, there is conflicting evidence regarding the effects of dexmedetomidine on the intraoperative neurophysiological monitoring of MEP and SSEP during surgery, particularly among pediatric patients.ObjectivesThis systematic review aimed to determine whether, during spinal fusion surgery in pediatric patients with scoliosis, dexmedetomidine alters MEP amplitude or SSEP latency and amplitude and, if so, whether different doses of dexmedetomidine display different effects (PROSPERO registration number CRD42022300562).MethodsWe searched PubMed, Scopus, and Cochrane Library on January 1, 2022 and included randomized controlled trials, observational cohort and case–control studies and case series investigating dexmedetomidine in the population of interest and comparing against a standardized anesthesia regimen without dexmedetomidine or comparing multiple doses of dexmedetomidine. Animal and in vitro studies and conference abstracts were excluded.ResultsWe found substantial heterogeneity in the risk of bias (per Cochrane‐preferred tools) of the included articles (n = 5); results are summarized without meta‐analysis. Articles with the lowest risk of bias indicated that dexmedetomidine was associated with MEP loss and that higher doses of dexmedetomidine increased risk. In contrast, articles reporting no association between dexmedetomidine and MEP loss suffered from higher risk of bias, including suspected or confirmed problems with confounding, outcome measurement, participant selection, results reporting, and lack of statistical transparency and power.ConclusionGiven the limitations of the studies available in the literature, it would be advisable to conduct rigorous randomized controlled trials with larger sample sizes to assess the effects of dexmedetomidine use of in scoliosis surgery in pediatric patients.

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“…Raynor et al also attributed recordings' changes to systemic factors. Interestingly, IONM changes were more common in revision surgeries than in primary [1,40,[68][69][70][71].…”

Section: Spinal Cord Surgerymentioning

confidence: 99%

“…Nevertheless, preoperative motor weakness or neuromuscular scoliosis decrease MEP recording value, still, Wang et al concluded MEP monitoring is feasible for most high risk diagnosis and complicated surgical procedures with sudden loss meaning postoperative neurological deficit. Nevertheless, patients with preoperative deficit may present neuromonitoring signal drop with normal spinal function, so that, stays as an important question if monitoring loss is a strong predictor of PND [14,21,23,50,68,71,72].…”

Section: Spinal Cord Surgerymentioning

confidence: 99%

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

Marafona¹,

Machado²

2017

J Anesth Clin Res

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Background: Nowadays, intraoperative evoked potentials are recommended in a variety of procedures but there is still a lack of standard protocols and consensus about warning criteria. Moreover, studies are now being made to fundament its risk-beneficial ratio through recordings' predictive value for short and long term outcomes. Furthermore, wake up test limitations encouraged intraoperative evoked potentials research, a reliable monitoring technology.

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Overview of Intraoperative Neurophysiological Monitoring During Spine Surgery

Cited by 17 publications

References 36 publications

Patient Care During Minimally Invasive Lateral Spine Surgery

Patient Care During Minimally Invasive Lateral Spine Surgery

The effects of dexmedetomidine on intraoperative neurophysiologic monitoring modalities during corrective scoliosis surgery in pediatric patients: A systematic review

Intraoperative Evoked Potentials: A Review of Clinical Impact and Limitations

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