Intraoperative neurophysiology is here to stay

Sala, Francesco

doi:10.1007/s00381-010-1090-5

Cited by 34 publications

(22 citation statements)

References 22 publications

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“…(9). From the other surgical procedures using IONM as spinal surgery to that of vascular, brain surgery, even the more accredited analyses (such as Cochrane reviews) fail to demonstrate class I evidence (1,(10)(11)(12). So, after all, we have to admit that the level of evidence based medicine in IONM is not worse than that found in general surgery generally and in thyroid surgery in particular (1).…”

Section: Is It Evidence-based?mentioning

confidence: 99%

“…The idea of applying techniques traditionally used in clinical neurophysiology within the operating room is not novel (1). IONM have been used for many years during neurosurgical procedures, spine surgery, vascular, plastic, Otolaryngology (ENT), etc.…”

Section: Introductionmentioning

confidence: 99%

“…IONM have been used for many years during neurosurgical procedures, spine surgery, vascular, plastic, Otolaryngology (ENT), etc. (1). Victor Riddel (2) wrote in 1970 on the British Journal of Surgery: "...…”

Section: Introductionmentioning

confidence: 99%

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The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

et al. 2018

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Numerous operating tools and technology transfers are available for thyroid surgery teams performing open, endoscopic and robotic procedures but none, or very few, of them constitutes a mandatory prerequisite. Over the past decade, the choice of intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve (RLN), has been reached certain consensus, which must at least be selected on an individual basis. Identification and intraoperative assessment of the RLN seems to be more effectively performed with IONM than solely visually or endoscopically. Today, IONM has evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. The transition from the concept of intermitted neural monitoring of the RLN to that of continuous functions evaluation that must be appreciate requires highly skilled knowledge of IONM. This goal will be more likely achieved in centers highly specialized in thyroid surgery.

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Section: Is It Evidence-based?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

et al. 2018

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“…When discussing the evidence supporting the use of intraoperative neuromonitoring for preventing neurological injury, a number of authors have pointed out the absence of controlled studies (that is, Class I evidence) addressing this topic, 3,22,30,33,51,52,63,66 with rare exceptions.…”

Section: Is a Blinded Study Necessary?mentioning

confidence: 99%

“…19,33,77 For example, Francesco Sala, a neurosurgeon who publishes frequently in the field wrote "It is very unlikely that Class I studies will ever occur in the field of IN" (intraoperative neuromonitoring), because: 1) "... a controlled study where patients are randomly assigned to a control group or a monitored group would be unethical and unacceptable to patient and surgeon alike;" and 2) sample sizes would be prohibitive, given the historically low incidence of severe injury. 66 A spirited discussion on this topic appeared recently in a series of letters to the editor, 46 with most respondents taking the position of Sala in the preceding quotation.…”

Section: Is a Blinded Study Ethical?mentioning

confidence: 99%

Neuromonitoring with pulse-train stimulation for implantation of thoracic pedicle screws: a blinded and randomized clinical study. Part 2. The role of feedback

Calancie¹,

Donohue

Moquin³

2014

SPI

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Object The authors have reported in Part 1 of this study on a novel neuromonitoring test for the prevention of medial malpositioning of thoracic pedicle screws. In the present paper they examine the impact of providing the results of the test as intraoperative feedback to the surgical team. Methods This is the second part of a 2-part report of a prospective, blinded and randomized neuromonitoring study designed to lower the incidence of medially malpositioned thoracic pedicle screws. Details of the neuromonitoring technique and data supporting the alarm criteria used are contained in the companion article (Part 1). For the majority of pedicle screw placements, intraoperative test results were withheld from the study team (that is, the team members were blinded to the test results). However, for a limited number of pedicle sites the authors provided one of 2 forms of testing feedback to the surgical team: 1) “break the blind” feedback, if testing suggested that screw placement would result in direct contact between screw and the dura mater; and 2) “planned” feedback, beginning during the later stages of the study and provided for 50% of pedicle sites. Feedback gave the surgeon the opportunity to adjust the trajectory that the screw would ultimately take within the pedicle. The final screw position relative to the pedicle's medial wall for all sites in which feedback was withheld from the surgical team was compared with the screw position for those sites in which either form of feedback (“break the blind” or “planned”) was provided to and acted upon by the surgical team. Results Of the 820 pedicle tracks tested among the 71 surgical cases included in this study, a total of 684 were operated upon without any form of feedback. Planned feedback was provided for an additional 107 pedicle tracks, of which 15 triggered an intraoperative alarm (evoked electromyogram response in leg muscles to stimulus intensity ≤ 10 mA) leading to a warning to the surgical team of a medially biased pedicle track. Finally, the blind was broken 29 times, in each case when testing revealed a particularly low threshold (≤ 4 mA) for evoked responses in leg muscles when stimulating along the pedicle track with the ball-tipped probe. As detailed in the companion paper to this one, there were 32 screws with threads lying at least 2 mm medial to the pedicle wall. In all 32 instances (100%), either these screws were in the “no feedback” category (n = 29) or they were in a feedback category but the surgeon elected to not revise the pedicle-track trajectory. Two patients returned to the operating room for revision of screw placements because the screws were encroaching upon the central canal; the pedicle tracks for these screws had been in the “no feedback” category. Conclusions This is the first blinded and randomized study to prove that implementing a novel neuromonitoring strategy during placement of thoracic pedicle screws can significantly reduce the incidence of clinically relevant thoracic pedicle screw medial malpositioning.

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