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Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues - surgeons' views.
EFORT Open Rev. 2020 Jan; 5(1):9-16.EO

Abstract

In spine deformity surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres.Prompt reaction within the reversible phase (reducing of compressive/distractive forces) usually restores functionality of the spinal cord, but if those forces continue to persist, a permanent neurological deficit might be expected.With monitoring of sensory pathways (dorsal column-medial lemniscus) by somatosensory-evoked potentials (SSEPs), such events are detected with a sensitivity of up to 92%, and a specificity of up to 100%.The monitoring of motor pathways by transcranial electric motor-evoked potentials (TceMEPs) has a sensitivity and a specificity of up to 100%, but it requires avoidance of halogenated anaesthetics and neuromuscular blockades.Different modalities of intraoperative neuromonitoring (IONM: SSEP, TceMEP, or combined) can be performed by the neurophysiologist, the technician or the surgeon. Combined SSEP/TceMEP performed by the neurophysiologist in the operating room is the preferable method of IONM, but it might be impractical or unaffordable in many institutions. Still, many spine deformity surgeries worldwide are performed without any type of IONM. Medicolegal aspects of IONM are different worldwide and in many cases some vagueness remains.The type of IONM that a spinal surgeon employs should be reliable, affordable, practical, and recognized by the medicolegal guidelines. Cite this article: EFORT Open Rev 2020;5:9-16. DOI: 10.1302/2058-5241.5.180032.

Authors+Show Affiliations

Department of Orthopedics, General Hospital Sarajevo, Bosnia and Herzegovina.Department of Intraoperative Neurophysiologic Monitoring, SMS, Louisville, Kentucky, USA.Department of Orthopedics, Sahlgrenska Academy at University of Gothenburg, Sweden.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32071769

Citation

Biscevic, Mirza, et al. "Intraoperative Neuromonitoring in Spine Deformity Surgery: Modalities, Advantages, Limitations, Medicolegal Issues - Surgeons' Views." EFORT Open Reviews, vol. 5, no. 1, 2020, pp. 9-16.
Biscevic M, Sehic A, Krupic F. Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues - surgeons' views. EFORT Open Rev. 2020;5(1):9-16.
Biscevic, M., Sehic, A., & Krupic, F. (2020). Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues - surgeons' views. EFORT Open Reviews, 5(1), 9-16. https://doi.org/10.1302/2058-5241.5.180032
Biscevic M, Sehic A, Krupic F. Intraoperative Neuromonitoring in Spine Deformity Surgery: Modalities, Advantages, Limitations, Medicolegal Issues - Surgeons' Views. EFORT Open Rev. 2020;5(1):9-16. PubMed PMID: 32071769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues - surgeons' views. AU - Biscevic,Mirza, AU - Sehic,Aida, AU - Krupic,Ferid, Y1 - 2020/01/29/ PY - 2020/2/20/entrez PY - 2020/2/20/pubmed PY - 2020/2/20/medline KW - intraoperative neuromonitoring KW - medicolegal issue KW - motor potentials KW - neurological deficit KW - safety KW - spinal deformity SP - 9 EP - 16 JF - EFORT open reviews JO - EFORT Open Rev VL - 5 IS - 1 N2 - In spine deformity surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres.Prompt reaction within the reversible phase (reducing of compressive/distractive forces) usually restores functionality of the spinal cord, but if those forces continue to persist, a permanent neurological deficit might be expected.With monitoring of sensory pathways (dorsal column-medial lemniscus) by somatosensory-evoked potentials (SSEPs), such events are detected with a sensitivity of up to 92%, and a specificity of up to 100%.The monitoring of motor pathways by transcranial electric motor-evoked potentials (TceMEPs) has a sensitivity and a specificity of up to 100%, but it requires avoidance of halogenated anaesthetics and neuromuscular blockades.Different modalities of intraoperative neuromonitoring (IONM: SSEP, TceMEP, or combined) can be performed by the neurophysiologist, the technician or the surgeon. Combined SSEP/TceMEP performed by the neurophysiologist in the operating room is the preferable method of IONM, but it might be impractical or unaffordable in many institutions. Still, many spine deformity surgeries worldwide are performed without any type of IONM. Medicolegal aspects of IONM are different worldwide and in many cases some vagueness remains.The type of IONM that a spinal surgeon employs should be reliable, affordable, practical, and recognized by the medicolegal guidelines. Cite this article: EFORT Open Rev 2020;5:9-16. DOI: 10.1302/2058-5241.5.180032. SN - 2058-5241 UR - https://www.unboundmedicine.com/medline/citation/32071769/Intraoperative_neuromonitoring_in_spine_deformity_surgery:_modalities,_advantages,_limitations,_medicolegal_issues_-_surgeons'_views. L2 - https://online.boneandjoint.org.uk/doi/full/10.1302/2058-5241.5.180032 DB - PRIME DP - Unbound Medicine ER -
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