Purpose of review: Intraoperative neurophysiological monitoring (IONM) during spine surgery has dramatically evolved over the past decade. A number of techniques have been recently proposed to monitor motor evoked potentials (MEPs), but contradictory results have been published, questioning their reliability to assess specifically the functional integrity of the motor pathways. The aim of the review is to present the state of the art of spinal cord monitoring and the different, complementary roles played by somatosensory evoked potentials (SEPs) and MEPs. Recent findings: The authors focused on recent publications analyzing the reliability of SEPs and different MEP techniques during surgeries for spine deformities, anterior-posterior stabilization or decompression, vertebrectomy, and discectomy. Finally, publications on nonsurgically induced changes in IONM parameters during spine orthopedic surgery, such as hypotension and hypothermia, are reviewed to emphasize their importance. Summary: The authors suggest that a combination of SEPs and transcranially elicited MEPs should be used during spine surgery because there is no scientific justification to favor either one of the two. Spinal epidural MEP recordings may be added in selective cases. Nonsurgically induced changes in IONM should be recognized and corrected to avoid misleading information on surgery-related evoked potential changes. © 2004 Lippincott Williams & Wilkins.
Intraoperative neurophysiological monitoring during spine surgery: an update
SALA, Francesco
2004-01-01
Abstract
Purpose of review: Intraoperative neurophysiological monitoring (IONM) during spine surgery has dramatically evolved over the past decade. A number of techniques have been recently proposed to monitor motor evoked potentials (MEPs), but contradictory results have been published, questioning their reliability to assess specifically the functional integrity of the motor pathways. The aim of the review is to present the state of the art of spinal cord monitoring and the different, complementary roles played by somatosensory evoked potentials (SEPs) and MEPs. Recent findings: The authors focused on recent publications analyzing the reliability of SEPs and different MEP techniques during surgeries for spine deformities, anterior-posterior stabilization or decompression, vertebrectomy, and discectomy. Finally, publications on nonsurgically induced changes in IONM parameters during spine orthopedic surgery, such as hypotension and hypothermia, are reviewed to emphasize their importance. Summary: The authors suggest that a combination of SEPs and transcranially elicited MEPs should be used during spine surgery because there is no scientific justification to favor either one of the two. Spinal epidural MEP recordings may be added in selective cases. Nonsurgically induced changes in IONM should be recognized and corrected to avoid misleading information on surgery-related evoked potential changes. © 2004 Lippincott Williams & Wilkins.
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