Intraoperative Monitoring for Spine Surgery in LMICs: Applications, Outcomes, and Access Disparities

Area of Science:

• Neurosurgery
• Spinal Surgery
• Neuromonitoring

Background:

• Intraoperative neuromonitoring (IONM) is crucial for protecting neural structures during spine surgery.
• IONM minimizes the risk of neurological complications, improving patient outcomes.
• Spine surgery in low- and middle-income countries faces challenges due to limited resources.

Purpose of the Study:

• To evaluate the effectiveness and challenges of implementing IONM in spine surgery, especially in resource-limited settings.
• To highlight the role of multimodal IONM in improving surgical precision and patient safety.
• To assess IONM's potential to reduce postoperative deficits and healthcare costs.

Main Methods:

• Utilized various IONM techniques including motor evoked potentials, electromyography, transcranial motor stimulation, and somatosensory evoked potentials.
• Focused on real-time monitoring of spinal cord and nerve function during surgery.
• Analyzed the application of multimodal IONM in resource-limited environments.

Main Results:

• IONM has demonstrated effectiveness in improving surgical precision and patient safety.
• Multimodal IONM is particularly beneficial in resource-limited settings for reducing neurological deficits and costs.
• Challenges such as infrastructure deficits, economic constraints, and lack of guidelines hinder wider IONM implementation.

Conclusions:

• IONM is a promising strategy for improving outcomes in high-risk spine surgery, particularly in resource-limited settings.
• Despite challenges, IONM integration can lead to better surgical results and reduced neurological deficits.
• Continued efforts are needed to overcome implementation barriers and standardize IONM practices.