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Intraoperative Neuromonitoring Changes During MIS-TLIF Associated with Postoperative Foot Drop
Michael C Oblich1, James G Lyman1, James M Mossner2
1Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
Journal of Clinical Medicine
|August 13, 2026
Summary
Intraoperative neuromonitoring (IOM) alerts during minimally invasive spine fusion surgery significantly predict postoperative foot drop. While IOM is a useful screening tool for foot drop, its ability to predict other rare complications is limited.
Area of Science:
- Neurosurgery
- Spine Surgery
- Orthopedics
Background:
- Intraoperative neuromonitoring (IOM) is frequently employed in instrumented spine surgery, yet its clinical utility remains a subject of debate.
- Assessing the independent association between IOM changes and specific postoperative outcomes is crucial for refining surgical practices.
Purpose of the Study:
- To investigate the correlation between intraoperative neuromonitoring alerts and postoperative outcomes in patients undergoing minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).
Main Methods:
- A retrospective analysis of 439 patients who underwent MIS-TLIF with IOM was conducted.
- Statistical analyses, including logarithmic regression, were used to evaluate the association between IOM alerts and postoperative complications.
- Data included patient demographics, surgical details, and IOM findings.
Main Results:
- Of 439 patients, 21 experienced an IOM alert. No preoperative factors predicted IOM alerts.
- IOM alerts significantly increased the likelihood of postoperative foot drop (p < 0.001) with high specificity (95.9%) and negative predictive value (99.8%).
- IOM alerts also predicted postoperative neurological deficits and chronic complications, with both SSEP and MEP subtypes showing significant association with foot drop.
Conclusions:
- Intraoperative neuromonitoring alerts during MIS-TLIF are associated with an increased risk of postoperative foot drop and other neurological deficits.
- IOM serves as an effective screening tool to rule out iatrogenic foot drop, but its predictive value for rare postoperative complications is limited.