The Impact of Neurophysiological Intraoperative Monitoring during Spinal Cord and Spine Surgery: A Critical Analysis of 121 Cases

Abstract

Neuromonitoring has been utilized during spinal surgery to assess the function of the spinal cord in an effort to prevent intraoperative injury. Although its use is widespread, no clear benefit has been demonstrated. Our goal in this study was to interrogate the value of intraoperative neuromonitoring in decreasing the severity and rate of neurological injury during and after spinal surgery. Here we describe our experience of 121 patients who underwent spinal cord procedures with the combination of intraoperative neuromonitoring, to determine its ability to detect neurological changes and the specificity and sensitivity in this setting. The data for the 121 patients who underwent neurophysiological monitoring during various spinal procedures was collected retrospectively. The patients were classified into one of four groups according to the findings of intraoperative monitoring and the clinical outcomes on postoperative neurological exam. Intraoperative monitoring was evaluated for its specificity, sensitivity, and predictive value. In our cohort of 121 patients, the use of intraoperative neuromonitoring had a low sensitivity, which may produce an excessive number of false negatives. Based on these findings, neuromonitoring seems to have a poor positive predictive value and is thus an inappropriate test to prevent harm to patients.

Safety of Intraoperative Neurophysiological Monitoring during Indirect Decompression in Lumbar Spinal Surgery - Descriptive Report

“…Ibrahim, et al studied 121 patients and concluded that neuromonitoring has a poor positive predictive value. They concluded it is an inappropriate test for preventing neurological injury [15].…”

The incidence and effect of tethered cord release for tethered cord syndrome in patients with myelomeningocele: a population-based study

“…Whether intraoperative neurophysiological monitoring may have changed outcome by enabling a more aggressive and sufficient surgical release is uncertain. [25][26][27] Nevertheless, axial pain in the back and pain in lower extremities seem to FIG. 2.…”

Intraoperative neurophysiological monitoring during thoracoscopic removal of the paravertebral spinal tumor (from practice)

“…Случай из практики стволов и сплетений определяют, стимулируя область расположения нервного ствола монополярным или биполярным зондом, т. е. осуществляя стимуляционную электромиографию [4][5][6]. Для получения достоверных результатов ИОНМ критически важно, чтобы во время проведения наркоза не применялись периферические миорелаксанты [7]. Опухоли позвоночника с паравертебральным прорастанием в полость грудной клетки встречаются относительно редко.…”

“…Статистика их распространенности отсутствует, а посвященные проблеме публикации ограничиваются описанием клинических случаев. Объемные образования такой локализации при гистологическом исследовании в большинстве случаев оказываются шванномами, берущими начало из блуждающего нерва [7,8]. Нередко они расположены недалеко от места прохождения диафрагмального нерва или же он пересекает саму опухоль [9].…”