Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist.

摘要: Spine surgery carries an inherent risk of damage to critical neural structures. Intraoperative neurophysiological monitoring (IONM) is frequently used improve the safety spine by providing real-time assessment structures at risk. Evidence-based guidelines for safe and efficacious use IONM are lacking its largely driven surgeon preference medicolegal issues. Due this lack standardization, preoperative sign-in serves as a opportunity 3-way discussion between neurosurgeon, anesthesiologist, neuromonitoring team regarding necessity goals in ensuing case. This analysis contains review commonly modalities including somatosensory evoked potentials, motor spontaneous or free-running electromyography, triggered combined multimodal IONM. For each modality methodology, interpretation, reported sensitivity specificity neurological injury addressed. followed important IONM-related issues include checklist, anesthetic protocol, warning criteria possible injury, consideration what steps take response positive alarm. The authors conclude with cost-effectiveness IONM, offer recommendations during various forms surgery, both complex minimally invasive procedures, well lower-risk spinal operations.