The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery

Abstract

Study Design: Narrative review. Objective: To summarize relevant studies regarding the utilization of intraoperative neurophysiological monitoring (IONM) techniques in spine surgery implemented in recent years. Methods: A literature search of the Medline database was performed. Relevant studies from all evidence levels have been included. Titles, abstracts, and reference lists of key articles were included. Results: Multimodal intraoperative neurophysiological monitoring (MIONM) has the advantage of compensating for the limitations of each individual technique and seems to be effective and accurate for detecting perioperative neurological injury during spine surgery. Conclusion: Although there are no prospective studies validating the efficacy of IONM, there is a growing body of evidence supporting its use during spinal surgery. However, the lack of validated protocols to manage intraoperative alerts highlights a critical knowledge gap. Future investigation should focus on developing treatment methodology, validating practice protocols, and synthesizing clinical guidelines.

Transabdominal Motor Action Potential Monitoring of Pedicle Screw Placement During Minimally Invasive Spinal Procedures: A Case Study

“…When the screw was replaced in the correct position, the signal returned to the normal value. This is in concordance with our predictions, as misplaced pedicle screws would be expected to result in an increased value if the nerve is impinged, given that an irritated nerve requires more energy to reach depolarization [19]. Thus, our findings support the efficacy of TaMAP as an informative tool in neuromonitoring.…”

Epidural Anesthesia With Low Concentration Ropivacaine and Sufentanil for Percutaneous Transforaminal Endoscopic Discectomy: A Randomized Controlled Trial

“…General anesthesia (GA) may increase the risk for complications because of nerve root anomalies. Intraoperative neurophysiologic monitoring (IONM) can be employed to minimize neurologic injury during surgery (12,13). However, this procedure has not been widely applied in many developing countries, especially in poor districts, due to the economic concern.…”

Successful Motor Evoked Potential Monitoring in Cervical Myelopathy : Related Factors and the Effect of Increased Stimulation Intensity

“…Some controversy remains about the overall efficacy of surgery for cervical myelopathy [ 7 , 14 ] although recent data have associated IONM with postoperative clinical outcome benefits [ 1 , 16 , 29 ]. Further research that utilizes larger samples, comparable and efficient stimulation protocols, and standardized outcome measures for longer follow-up periods may shed some light on this matter.…”