Current opinions and recommendations on multimodal intraoperative monitoring during spine surgeries

The prevention of neural complications in the surgical treatment of scoliosis: the role of the neurophysiological intraoperative monitoring

“…Timely detection of impending spinal cord damage is paramount. The first consensus meeting on intraoperative monitoring during spine surgery in Verona in 2006 [10] recommended the use of IOM in all spinal surgical procedures bearing a potential risk of damaging neural structures. In particular, the consensus group agreed that IOM can be recommended for corrections of spinal deformities with scoliosis greater than 45°and corrections of congenital spinal anomalies.…”

“…In 1992 a Scoliosis Research Society study concluded that the use of intraoperative spinal cord neurophysiological monitoring during operative procedures including instrumentation should be considered ''a viable alternative as well as an adjunct to the use of the wake-up test during spinal surgery'' [8]. Nevertheless, it is well known that the use of SEPs alone may be ineffective in detecting a motor tract deficit [9,10]. As a result, various methods for monitoring the motor tract of the spinal cord have been developed.…”

A survey of the “surgical and research” articles in the European Spine Journal, 2007

“…We are introduced to the concept of multimodal intraoperative monitoring, and that it consists of intraoperative spinal and cortical-evoked potentials combined with continuous EMG and motor evoked potentials of muscles [50]. We are provided with an American view, by a neurologist, anesthesiologist and spine surgeon [36], and then a number of papers dealing with its use and results in various types of spinal surgery, principally from the Schulthess Clinic Zurich, Switzerland [14][15][16]51], from Italy [43] and Saudi Arabia [33]. These papers cover the use of MIOM in the thoracolumbar spine, the thoracic spine, the cervical spine, dealing with stenosis and deformity, and also intramedullary tumors [43,51].…”

“…We are provided with an American view, by a neurologist, anesthesiologist and spine surgeon [36], and then a number of papers dealing with its use and results in various types of spinal surgery, principally from the Schulthess Clinic Zurich, Switzerland [14][15][16]51], from Italy [43] and Saudi Arabia [33]. These papers cover the use of MIOM in the thoracolumbar spine, the thoracic spine, the cervical spine, dealing with stenosis and deformity, and also intramedullary tumors [43,51]. I particularly enjoyed the paper by Sala, as it indicated the particular value of each monitoring system as one dissected into the cord in removing a tumor, allowing one to understand the necessity for a multimodal system.…”

Intraoperative neurophysiological monitoring for the anaesthetist

“…1 The progression from using somatosensory-evoked potentials (SSEPs) alone, to the multimodal use of both SSEPs and motor-evoked potentials (MEPs) to monitor both dorsal sensory pathways and the anterior corticospinal tracts, provides the optimum monitoring environment in which to prevent false negative and positive results. 2 The use of brainstem auditory-evoked potentials (BAEPs) for posterior fossa surgery, as well as cortical mapping techniques, provides a further buffer of safety when resecting tumours in highly sensitive areas.…”