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Intraoperative Neurophysiological Monitoring in Full-Endoscopic Cervical Endoscopic ULBD.

Miles Hudson1, Sarah Esposito1, Mark M Zaki2

  • 1Mayo Clinic Department of Neurosurgery, 5777 E Mayo Blvd, Phoenix, AZ 85085, USA.

Journal of Clinical Medicine
|January 10, 2026
PubMed
Summary
This summary is machine-generated.

Patients with severe cervical stenosis undergoing decompression surgery face a higher risk of neurological deficits. Intraoperative neurophysiological monitoring (IONM) effectively predicts these deficits, acting as an early warning system.

Keywords:
cervicalcervical myelopathyendoscopicmotor evoked potentialsspinal stenosisspinesurgical complicationstransforaminal

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Area of Science:

  • Neurosurgery
  • Spinal Surgery
  • Neurology

Background:

  • Cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD) is a surgical procedure for spinal stenosis.
  • Identifying risk factors for postoperative neurological deficits is crucial for patient safety.

Purpose of the Study:

  • Evaluate risk factors for neurological deficits after CE-ULBD.
  • Determine if intraoperative neurophysiological monitoring (IONM) can predict neurological compromise.

Main Methods:

  • Multicenter retrospective review of 33 CE-ULBD cases (2016-2024).
  • Analysis of demographic, operative, and neurophysiological variables.
  • Correlation of IONM data (electromyography, motor evoked potentials) with postoperative weakness.

Main Results:

  • Postoperative weakness occurred in 12.1% of patients, all with severe preoperative stenosis.
  • Sustained motor evoked potential decrease during surgery predicted new postoperative weakness (100% correlation).
  • Severe stenosis and preoperative weakness are significant risk factors.

Conclusions:

  • Patients with severe cervical stenosis and preoperative weakness are at increased risk for neurological deficits post-CE-ULBD.
  • IONM changes strongly correlate with new deficits, serving as an early warning.
  • Caution with irrigation pressure is advised in severe stenosis cases.