Intraoperative monitoring may prevent neurologic injury in non-myelopathic patients undergoing ACDF

The efficacy of spinal cord monitoring for patients undergoing anterior cervical discectomy and fusion (ACDF) as indicated for radiculopathy without myelopathy is debated in the literature. The reported rate of complications is low for this procedure. Previous studies have shown both improvements in outcome as well as no change in monitored vs. unmonitored patients. We report two cases where intraoperative spinal cord monitoring using somatosensory and transcranial motor evoked potentials detected impending iatrogenic injury to the spinal cord. In both cases, changes in the electrophysiological data prompted intervention and prevented a permanent neurological deficit. Based on these observations we recommend spinal cord monitoring using sensory and motor evoked potentials to prevent new deficits in non-myelopathic patients undergoing ACDF surgery.