European Spine Journal

, Volume 16, Supplement 2, pp 221–228 | Cite as

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

  • Martin A. Sutter
  • Andreas Eggspuehler
  • Dieter Grob
  • Francois Porchet
  • Dezsö Jeszenszky
  • Jiri Dvorak
Original Article


A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal- and cortical-evoked potentials, combined with continuous EMG- and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented true-negative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results.


Spine surgery Lumbar spinal stenosis Intraoperative monitoring Sensitivity Specificity 



Dr. Lote Medicus fund for the financial support of the development of MIOM at the Schulthess Clinic. Dave O’Riordan and Charles McCammon for helping with the manuscript. Anne Mannion, PhD, for the critical review of the manuscript. A special thanks to Professor Arnaldo Benini who supported the study with his patients.

Conflict of interest statement None of the authors has any potential conflict of interest.


  1. 1.
    Agazzi S, Reverdin A, May D (1999) Posterior lumbar interbody fusion with cages: an independent review of 71 cases. J Neurosurg 91:186–192PubMedGoogle Scholar
  2. 2.
    Bose B, Wierzbowski LR, Sestokas AK (2002) Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar spine surgery. Spine 27:1444–1450PubMedCrossRefGoogle Scholar
  3. 3.
    Brantigan JW, Steffee AD, Lewis ML, Quinn LM, Persenaire JM (2000) Lumbar interbody fusion using the Brantigan I/F cage for posterior lumbar interbody fusion and the variable pedicle screw placement system: two-year results from a Food and Drug Administration investigational device exemption clinical trial. Spine 25:1437–1446PubMedCrossRefGoogle Scholar
  4. 4.
    Darden BV II, Wood KE, Hatley MK, Owen JH, Kostuik J (1996) Evaluation of pedicle screw insertion monitored by intraoperative evoked electromyography. J Spinal Disord 9:8–16PubMedGoogle Scholar
  5. 5.
    Elias WJ, Simmons NE, Kaptain GJ, Chadduck JB, Whitehill R (2000) Complications of posterior lumbar interbody fusion when using a titanium threaded cage device. J Neurosurg 93:45–52PubMedGoogle Scholar
  6. 6.
    Glassman SD, Dimar JR, Puno RM, Johnson JR, Shields CB, Linden RD (1995) A prospective analysis of intraoperative electromyographic monitoring of pedicle screw placement with computed tomographic scan confirmation. Spine 20:1375–1379PubMedGoogle Scholar
  7. 7.
    Okuyama K, Abe E, Suzuki T, Tamura Y, Chiba M, Sato K (1999) Posterior lumbar interbody fusion: a retrospective study of complications after facet joint excision and pedicle screw fixation in 148 cases. Acta Orthop Scand 70:329–334PubMedCrossRefGoogle Scholar
  8. 8.
    Pihlajamaki H, Myllynen P, Bostman O (1997) Complications of transpedicular lumbosacral fixation for non-traumatic disorders. J Bone Joint Surg Br 79:183–189PubMedCrossRefGoogle Scholar
  9. 9.
    Sutter M, Eggspühler A, Grob D, Jeszenszky D, Porchet F, Muller A, Dvorak J (2007) The diagnostic value of multimodal intraoperative monitoring (MIOM) during spine surgery: a prospective study of 1017 cases. Eur Spine J Jul 31; [Epub ahead of print]Google Scholar
  10. 10.
    Sutter M, Eggspühler A, Muller A, Dvorak J (2007) Multimodal intraoperative monitoring: methodology. Eur Spine J Jul 26; [Epub ahead of print]Google Scholar
  11. 11.
    Thomsen K, Christensen FB, Eiskjaer SP, Hansen ES, Fruensgaard S, Bunger CE (1997) 1997 Volvo Award winner in clinical studies: the effect of pedicle screw instrumentation on functional outcome and fusion rates in posterolateral lumbar spinal fusion: a prospective, randomized clinical study. Spine 22:2813–2822PubMedCrossRefGoogle Scholar
  12. 12.
    Toleikis JR, Carlvin AO, Shapiro DE, Schafer MF (1993) The use of dermatomal evoked responses during surgical procedures that use intrapedicular fixation of the lumbosacral spine. Spine 18:2401–2407PubMedCrossRefGoogle Scholar
  13. 13.
    Welch WC, Rose RD, Balzer JR, Jacobs GB (1997) Evaluation with evoked and spontaneous electromyography during lumbar instrumentation: a prospective study. J Neurosurg 87:397–402PubMedCrossRefGoogle Scholar
  14. 14.
    Winkler T, Sharma H, Stalberg E (1998) Spinal cord bioelectric activity, edema and cell injury following a focal trauma to the rat spinal cord: an experimental study using pharmacological and morphological approaches. Springer, BerlinGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Martin A. Sutter
    • 1
  • Andreas Eggspuehler
    • 1
  • Dieter Grob
    • 2
  • Francois Porchet
    • 3
  • Dezsö Jeszenszky
    • 4
  • Jiri Dvorak
    • 1
  1. 1.Department of Neurology, Spine UnitSchulthess ClinicZurichSwitzerland
  2. 2.Department of OrthopaedicsSchulthess ClinicZurichSwitzerland
  3. 3.Department of Neurosurgery, Spine UnitSchulthess ClinicZurichSwitzerland
  4. 4.Department of Orthopaedics, Spine UnitSchulthess ClinicZurichSwitzerland

Personalised recommendations