Keywords
Neurophysiological technique
Spinal surgery
Multimodal approach
Neural pathway
How to Cite
Abstract
Intraoperative neurophysiological monitoring (IONM) is an important method used in spinal surgery, which is aimed at the maintenance of the functional integrity of the nervous system, in particular, the spinal cord and its neural structures. This is a narrative review that focuses on the effect of IONM on postoperative neurological outcomes. The search was conducted in electronic databases covering the studies published in the last five years (2015 to 2025) and included the following study types: clinical studies, observational studies, systematic reviews, and key case series; all studies were excluded based on the following criterion: animal study, non-spinal surgeries, and lack of outcome data. It has been shown that IONM is an important way of improving the safety of spinal surgery, especially in high-risk surgery like intramedullary or extramedullary tumor resections, cervical myelopathy, and corrections to spinal deformities. IONM can help prevent postoperative complications and enhance recovery by enabling surgical teams to act in time to prevent neurological compromise, which results in postoperative complications and death. Multimodal monitoring Multimodal monitoring, which includes somatosensory evoked potential (SSEPs), motor evoked potential (MEPs), electromyography (EMG), and D-wave recording, provides a complete real-time evaluation of both sensory and motor pathways and has been shown to be particularly useful in complicated situations. IONM is based on the presence of qualified personnel and effective communication between surgeons and anesthesiologists and monitoring specialists during operations. Possible shortcomings are the absence of false negatives, inconsistency in sensitivity between different pathologies and the requirement of specific equipment and training. However, systematic reviews indicate that the routine use of IONM in the high-complexity spinal surgery procedures is cost-effective, decreases complications, reoperation, and the expenses of healthcare in the long run. The more advanced technologies, standardization of protocols and the wide availability of trained personnel are likely to increase IONM utility even more. IONM is a required precaution in spinal surgery today that allows anesthetists to identify and avert neural injury early in the course of surgery and enhances the patient’s safety and future neurological performance.
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