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Intraoperative neuromonitoring use in posterior endoscopic cervical decompression: can it reduce complications?
Vit Kotheeranurak1, Peem Sarasombath2, Khanathip Jitpakdee3
1Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand. vitinspine@gmail.com.
Summary
Intraoperative neuromonitoring (IONM) during posterior endoscopic cervical decompression (PECD) surgery enhances decision-making and safety, though it doesn't predict all outcomes. All patients showed improved symptoms regardless of IONM use.
Area of Science:
- Neurosurgery
- Spine Surgery
- Orthopedics
Background:
- Posterior endoscopic cervical decompression (PECD) is used for cervical spondylotic radiculopathy (CSR) and herniated nucleus pulposus (HNP).
- The utility of intraoperative neuromonitoring (IONM) in PECD remains debated despite its potential for real-time neurological assessment.
Purpose of the Study:
- To evaluate the impact and necessity of IONM in patients undergoing PECD.
- To explore solutions for improving IONM utilization in cervical spine surgery.
Main Methods:
- Retrospective cohort study of 140 patients with single-segment CSR or HNP (2020-2023).
- Comparison of 70 patients with PECD + IONM versus 70 patients with PECD alone.
- Assessment of neurological status, IONM data, surgery duration, complications, Neck Disability Index (NDI), visual analog scale (VAS), and modified MacNab criteria.
Main Results:
- All 140 patients demonstrated postoperative neurological improvement and no deficits.
- Significant improvements in VAS, NDI, and MacNab criteria were observed at 12 months in both groups.
- IONM changes were noted in 60 patients, while 10 showed no changes, yet all achieved positive outcomes.
Conclusions:
- IONM aids surgical decision-making and surgeon confidence, even with limited predictive value for postoperative deficits.
- IONM alarms are crucial for identifying and managing potential complications, enhancing patient safety.
- Advancements in IONM technology are expected to further optimize orthopedic surgical results.
