Neurophysiologic Intraoperative Monitoring for Spine Surgery: A Practical Guide From Past to Present.

Area of Science:

• Neurology
• Neurosurgery
• Neurophysiology

Background:

• Intraoperative neuromonitoring (IOM) emerged in the late 20th century to reduce patient morbidity during complex neurological surgeries.
• Its application has expanded significantly from scoliosis surgery to spinal tumor resections and cerebral ischemia monitoring.
• Professional bodies like the American Academy of Neurology (AAN) and American Clinical Neurophysiology Society (ACNS) endorse IOM for spinal surgery.

Purpose of the Study:

• To provide a comprehensive review of intraoperative neuromonitoring techniques for central and peripheral nervous system surgeries.
• To highlight technical, surgical, and anesthesia factors crucial for optimizing patient outcomes.
• To discuss troubleshooting measures for managing intraoperative neurophysiological changes.

Main Methods:

• Review of established and advanced intraoperative neuromonitoring techniques.
• Discussion of multimodal approaches combining SSEPs, MEPs, sEMG, tEMG, and D waves.
• Analysis of factors influencing IOM efficacy and interpretation.

Main Results:

• A multimodal IOM approach maximizes sensitivity and specificity in diagnosing reversible insults to the spinal cord, nerve roots, and peripheral nerves.
• IOM, particularly using SSEPs and MEPs, is recommended for predicting risks of paraparesis, paraplegia, and quadriplegia in spinal surgery.
• Effective IOM relies on interdisciplinary collaboration among surgical, anesthesia, and neuromonitoring teams.

Conclusions:

• Intraoperative neuromonitoring is a critical component of patient safety in neurosurgery.
• Optimizing IOM requires careful consideration of technical, surgical, and anesthetic variables.
• Proactive management of IOM changes is essential for preventing neurological deficits.