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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.
Purpose:
This study aimed to address the challenges and explore potential solutions for improving IONM utilization. Posterior endoscopic cervical decompression (PECD) relieves pressure on the exiting nerve root and spinal cord, potentially leading to improvements in patient symptoms. The routine use of intraoperative neuromonitoring (IONM) currently remains debatable, despite its ability to provide additional real-time neurological observation beyond standard practice.
Methods:
In this retrospective cohort study, we investigated the clinical data of 140 patients with single-segment cervical spondylotic radiculopathy (CSR) or herniated nucleus pulposus (HNP) from 2020 to 2023. Seventy patients underwent PECD with IONM (IONM group), whereas the remaining 70 patients did not undergo IONM. For both groups, neurological status, IONM data, duration of surgery, and complications were recorded. The curative effect was assessed based on the Neck Disability Index (NDI), visual analog scale (VAS) for arm and neck discomfort, and the modified MacNab criteria.
Results:
One hundred and forty patients diagnosed with unilateral single-segment CSR or HNP were included; 70 patients underwent PECD with IONM, 60 showed IONM changes, whereas 10 did not. Despite this, all 140 patients in both groups experienced postoperative neurological improvement without deficits, with significant enhancements in the VAS, NDI, and modified MacNab criteria scores, notably at the 12-month mark.
Conclusion:
IONM enhances surgical decision-making and strengthens surgeon confidence despite its limited predictive ability for postoperative deficits. IONM alarms swiftly identify and address potential complications, thereby supporting patient safety. Continued advancements in IONM technology hold promise for further optimization of orthopedic surgical outcomes.
