Intraoperative Neurophysiological Monitoring in Spinal Lesions Surgeries

Abstract

Although relatively infrequent, neurological injury is a much dreaded complication in spine surgery and has the potential to result in serious postoperative motor and sensory deficits. In recent years, an increase in the utilization of intraoperative neurophysiological monitoring (IONM) has been noted in an effort to avert these neurological complications. This technology allows intraoperative assessment of spinal cord function through real-time feedback from sensory tracts, motor tracts, and individual nerve roots. Currently, the most commonly employed IONM techniques for spinal procedures include (1) somatosensory sensory evoked potentials (SSEPs), (2) motor-evoked potentials (MEPs), and (3) spontaneous and triggered electromyography (EMG). Despite advancements in the understanding of IONM and the popularity of this technique in modern spine surgery, controversies still exist regarding its effectiveness and the necessity for its use in routine spinal procedures. Also, as modern health care shifts toward value-based systems, questions arise as to the exact cost-effectiveness of IONM.