Intraoperative neurophysiological monitoring in spinal surgery: Current status, applications and evidence
DOI:
https://doi.org/10.70577/55ydew64Keywords:
Intraoperative Neurophysiological Monitoring, Spinal Surgery, Motor Evoked Potentials, Somatosensory Evoked Potentials, Surgical Safety.Abstract
Intraoperative neurophysiological monitoring is a fundamental tool for preventing neurological injuries during spinal surgery. The aim of this narrative review was to analyze the current status of intraoperative neurophysiological monitoring, its main modalities, clinical applications, and the scientific evidence supporting its use in spinal procedures. A bibliographic search was conducted in international scientific databases, including PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar, selecting studies related to somatosensory evoked potentials, motor evoked potentials, electromyography, and multimodal monitoring in spinal surgery. The findings showed that the combination of different monitoring modalities increases diagnostic sensitivity and improves the early detection of intraoperative neurological alterations. Furthermore, multimodal monitoring contributes to reducing the risk of permanent neurological deficits in complex procedures such as spinal deformity correction, spinal cord tumor resection, and spinal instrumentation. It is concluded that intraoperative neurophysiological monitoring is an effective strategy to enhance surgical safety and preserve neurological function during spinal surgery.
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Ajiboye, R. M., Zoller, S. D., D'Oro, A., Ashana, A. O., Wang, J. C., & Singh, K. (2017). Intraoperative neuromonitoring for adult spinal deformity surgery: A systematic review. Spine Deformity, 5(1), 1–8. https://doi.org/10.1016/j.jspd.2016.08.002 DOI: https://doi.org/10.1016/j.jspd.2016.08.002
Ajiboye, R. M., Zoller, S. D., D'Oro, A., Ashana, A. O., Wang, J. C., & Singh, K. (2017). Intraoperative neuromonitoring for adult spinal deformity surgery: A systematic review. Spine Deformity, 5(1), 1–8. https://doi.org/10.1016/j.jspd.2016.08.002 DOI: https://doi.org/10.1016/j.jspd.2016.08.002
Balzer, J., Van Gompel, J., & Skinner, S. (2010). Telemedicine and intraoperative neurophysiological monitoring. Journal of Clinical Monitoring and Computing, 24(2), 101–107. https://doi.org/10.1007/s10877-010-9232-8
Deletis, V., & Sala, F. (2008). Intraoperative neurophysiology of the corticospinal tract. Advances and Technical Standards in Neurosurgery, 33, 115–144. https://doi.org/10.1007/978-3-211-72278-4_4
Fehlings, M. G., Brodke, D. S., Norvell, D. C., & Dettori, J. R. (2010). The evidence for intraoperative neurophysiological monitoring in spine surgery. Spine, 35(9 Suppl), S37–S46. https://doi.org/10.1097/BRS.0b013e3181d8338e DOI: https://doi.org/10.1097/BRS.0b013e3181d8338e
Fehlings, M. G., Brodke, D. S., Norvell, D. C., & Dettori, J. R. (2010). The evidence for intraoperative neurophysiological monitoring in spine surgery. Spine, 35(9 Suppl), S37–S46. https://doi.org/10.1097/BRS.0b013e3181d8338e DOI: https://doi.org/10.1097/BRS.0b013e3181d8338e
Ghadirpour, R., Nasi, D., Iaccarino, C., & Mazzatenta, D. (2018). Intraoperative neurophysiological monitoring in spine surgery. Acta Bio Medica, 89(1-S), 133–139. https://doi.org/10.23750/abm.v89i1-S.7026
Ghasemloonia, A., Khosravi, A., & Nahavandi, S. (2024). Artificial intelligence applications in intraoperative neurophysiological monitoring: Current perspectives and future directions. Frontiers in Neurology, 15, 1365987. https://doi.org/10.3389/fneur.2024.1365987
Hyun, S. J., Kim, K. J., Jahng, T. A., & Kim, H. J. (2017). Multimodal intraoperative monitoring in spine surgery: A review. Asian Spine Journal, 11(4), 680–689. https://doi.org/10.4184/asj.2017.11.4.680
Kim, S. M., Kim, S. H., Seo, D. W., & Lee, K. W. (2017). Intraoperative neurophysiologic monitoring: Basic principles and recent update. Journal of Korean Medical Science, 32(8), 1261–1269. https://doi.org/10.3346/jkms.2017.32.8.1261
Kim, S. M., Kim, S. H., Seo, D. W., & Lee, K. W. (2017). Intraoperative neurophysiologic monitoring: Basic principles and recent update. Journal of Korean Medical Science, 32(8), 1261–1269. https://doi.org/10.3346/jkms.2017.32.8.1261
Kothbauer, K. F., Deletis, V., & Epstein, F. J. (1998). Intraoperative spinal cord monitoring for intramedullary surgery. Neurosurgical Focus, 4(5), e6. https://doi.org/10.3171/foc.1998.4.5.7 DOI: https://doi.org/10.3171/foc.1998.4.5.4
Lenke, L. G., Padberg, A. M., Russo, M. H., Bridwell, K. H., Gelb, D. E., & Lehman, R. A. (2018). Triggered electromyographic threshold for accuracy of pedicle screw placement. Spine, 43(10), E576–E581. https://doi.org/10.1097/BRS.0000000000002425 DOI: https://doi.org/10.1097/BRS.0000000000002425
Lieberman, J. A., Lyon, R., Feiner, J., & Lieberman, I. H. (2008). The efficacy of intraoperative neurophysiological monitoring in detecting pedicle screw breaches. Spine, 33(24), 2644–2649. https://doi.org/10.1097/BRS.0b013e318188b3c7 DOI: https://doi.org/10.1097/BRS.0b013e318175c292
MacDonald, D. B., Skinner, S., Shils, J., & Yingling, C. (2013). Intraoperative motor evoked potential monitoring – A position statement by the American Society of Neurophysiological Monitoring. Clinical Neurophysiology, 124(12), 2291–2316. https://doi.org/10.1016/j.clinph.2013.07.025 DOI: https://doi.org/10.1016/j.clinph.2013.07.025
Neira, J. A., Reier, P. J., & Shields, C. B. (2023). Advances in intraoperative neurophysiological monitoring technologies for spine surgery. Neurosurgical Review, 46(1), 117. https://doi.org/10.1007/s10143-023-01978-2
Nuwer, M. R., Emerson, R. G., Galloway, G., Legatt, A. D., Lopez, J., Minahan, R., Yamada, T., Goodin, D. S., Armon, C., & Chaudhry, V. (2012). Evidence-based guideline update: Intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials. Neurology, 78(8), 585–589. https://doi.org/10.1212/WNL.0b013e318247f6bb DOI: https://doi.org/10.1212/WNL.0b013e318247fa0e
Raynor, B. L., Bright, J. D., Lenke, L. G., Rahman, R. K., Bridwell, K. H., & Padberg, A. M. (2007). Significant change or loss of intraoperative monitoring data: A 25-year experience in pediatric spinal deformity surgery. Spine, 32(19), 2099–2107. https://doi.org/10.1097/BRS.0b013e318145a5f0
Sala, F., Palandri, G., & Basso, E. (2007). Motor evoked potential monitoring improves outcome after surgery for intramedullary spinal cord tumors. Neurosurgery, 60(4 Suppl 2), 312–319. https://doi.org/10.1227/01.NEU.0000255412.20210.21
Skinner, S., Kothbauer, K., & Sala, F. (2019). Current practice of remote intraoperative neurophysiological monitoring. Clinical Neurophysiology Practice, 4, 148–154. https://doi.org/10.1016/j.cnp.2019.06.002 DOI: https://doi.org/10.1016/j.cnp.2019.06.002
Sloan, T. B., Heyer, E. J., & Jameson, L. (2015). Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. Journal of Clinical Neurophysiology, 32(1), 11–16. https://doi.org/10.1097/WNP.0000000000000143 DOI: https://doi.org/10.1097/WNP.0000000000000143
Sloan, T. B., Heyer, E. J., & Jameson, L. (2015). Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. Journal of Clinical Neurophysiology, 32(1), 11–16. https://doi.org/10.1097/WNP.0000000000000143 DOI: https://doi.org/10.1097/WNP.0000000000000143
Thirumala, P. D., Zhou, J., & Balzer, J. (2016). Diagnostic accuracy of motor evoked potentials to detect neurological deficit during idiopathic scoliosis correction. Clinical Neurophysiology, 127(1), 582–588. https://doi.org/10.1016/j.clinph.2015.03.047
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Copyright (c) 2026 Jimmy Fernando Yaguana Torres,Jorge Abel Anoceto Díaz, Renata Geovanna Palacios Rodríguez, Valeria María Guerrero Vélez, Hugo Joseph Behr Leyton (Autor/a)
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