Skip to main content
SpringerLink
Log in
Book cover

Handbook of Spine Technology pp 1–22Cite as

Intraoperative Monitoring in Spine Surgery

  • Living reference work entry
  • First Online:

  • 129 Accesses

Abstract

Intraoperative neuromonitoring (IOM) has been introduced into the field of surgical medicine as a series of diagnostic modalities. IOM may help to prevent perioperative injury to the spinal cord and nerve roots during spine procedures. Neurophysiologists are trained specialists who work together with other members of the surgical team to create and record electrical signals within the nervous system closely related to motor and sensory function. Electromyography (EMG) and evoked potentials (EPs) are monitored throughout the operation, and surgeons are alerted when waveforms change and specific alarm criteria have been breached. A multimodality approach to spinal cord monitoring seems to be the most effective method of using IOM. The use of IOM has not been established as a standard of care, IOM continues to be used more frequently by surgeons across the world and its favorability continues to expand. The future of IOM as it relates to spine surgery will depend largely on the advancements in electrical technology and continued research on the effectiveness of IOM techniques within certain populations criteria.

This is a preview of subscription content, log in via an institution.

References

  • Acharya S, Palukuri N, Supta P, Kohli M (2017) Transcranial motor evoked potentials during spinal deformity corrections- safety, efficacy, limitations, and the role of a checklist. Front Surg 4(8):1–11

    Google Scholar 

  • Ajiboye RM, Park HY, Cohen JR, Vellios EE, Lord EL, Ashana AO, Buser Z, Wang JC (2017) Demographic trends in the use of intraoperative neuromonitoring for scoliosis surgery in the United States. Int J Spine Surg 11:271–277

    Google Scholar 

  • ASNM (2009a) Guideline 11A: recommended standards for neurophysiologic intraoperative monitoring – principles. American Clinical Neurophysiology Society. https://www.acns.org/pdf/guidelines/Guideline-11A.pdf. Accessed 10 May 2018

  • ASNM (2009b) Guideline 11B: recommended standards for neurophysiologic intraoperative monitoring of somatosensory evoked potentials. American Clinical Neurophysiology Society. https://www.acns.org/pdf/guidelines/Guideline-11B.pdf. Accessed 10 May 2018

  • Calancie B, Madsen P, Lebwohl N (1994) Stimulus-evoked EMG monitoring during transpedicular lumbosacral spine instrumentation. Spine 19:2780–2786

    CAS  PubMed  Google Scholar 

  • Calancie B, Harris W, Broton JG, Alexeeva N, Green BA (1998) “Threshold-level” multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring. J Neurosurg 88:457–470

    CAS  PubMed  Google Scholar 

  • Daube JR, Rubin DI (2009) Needle electromyography. Muscle Nerve 39:244–270

    PubMed  Google Scholar 

  • Deletis V, Sala F (2008) Corticospinal tract monitoring with D- and I- waves from the spinal cord and muscle MEPs from limb muscles. In: Nuwer MR (ed) Intraoperative monitoring of neural function: handbook of clinical neurophysiology, vol 8. Elsevier, Amsterdam, pp 235–251

    Google Scholar 

  • Djurasovic M, Dimar JR, Glassman SD (2005) A prospective analysis of intraoperative electromyographic monitoring of posterior cervical screw fixation. J Spinal Disord Tech 18:515–518

    PubMed  Google Scholar 

  • Donohue ML, Murtagh-Schaffer C, Basta J, Moquin RR, Bashir A, Calancie B (2008) Pulse-train stimulation for detecting medial malpositioning of thoracic pedicle screws. Spine 33:E378–E385

    PubMed  Google Scholar 

  • Gertler R, Joshi GP (2010) General anesthesia. In: Twersky RS, Philip BK (eds) Handbook of ambulatory anesthesia, 2nd edn. Springer, New York, pp 234–251

    Google Scholar 

  • Gonzalez AA, Shilian P (2015) Somatosensory evoked potentials in: Barry B (ed) a practical approach to neurophysiologic intraoperative monitoring, 2nd edn. Demos Medical, New York, pp 18–32

    Google Scholar 

  • Holland NR (2002) Intraoperative electromyography. J Clin Neurophysiol 19:444–453

    PubMed  Google Scholar 

  • Holland N (2012) Neurophysiological assessment of thoracic and cervical pedicle screw integrity. J Clin Neurophysiol 39:489–492

    Google Scholar 

  • Husain AM (2015) A practical approach to neurophysiologic intraoperative monitoring. Demos Medical, New York

    Google Scholar 

  • Ibrahim T, Mrowczynski O, Zalatimo O, Chinchilli V, Sheehan J, Harbaugh R, Rizk E (2017) The impact of neurophysiological intraoperative monitoring during spinal cord and spine surgery: a critical analysis of 121 cases. Cureus 9:e1861. https://doi.org/10.7759/cureus.1861

    Article  PubMed  PubMed Central  Google Scholar 

  • Jameson L (2017) Acute loss of intraoperative evoked potential signals. In: McEvoy MD, Furse CM (eds) Advanced perioperative crisis management. New York, Oxford, pp 504–510

    Google Scholar 

  • Langeloo DD, Journée HL, Kleuver M, Grotenhuis JA (2007) Criteria for transcranial electrical motor evoked potential monitoring during spinal deformity surgery a review and discussion of the literature. Clin Neurophysiol 37:431–439

    Google Scholar 

  • Laratta JL, Ha A, Shillingford JN, Makhni MC, Lombardi JM, Thuet E, Lehman RA, Lenke LG (2018) Neuromonitoring in spinal deformity surgery: a multimodality approach. Glob Spine J 8:68–77

    Google Scholar 

  • Lee KD, Lyo U, Kang BS, Sim HB, Kwon SC, Park ES (2014) Accuracy of pedicle screw insertion using fluoroscopy-based navigation-assisted surgery: computed tomography postoperative assessment in 96 consecutive patients. J Korean Neurosurg 56:16–20

    CAS  Google Scholar 

  • Legatt AD, Emerson RG, Epstein CM, MacDonald DB, Deletis V, Bravo RJ, López JR (2016) ACNS guideline: transcranial electrical stimulation motor evoked potential monitoring. J Clin Neurophysiol 33:42–50

    PubMed  Google Scholar 

  • Leppanen RE (2005) Intraoperative monitoring of segmental spinal nerve root function with free-run and electrically-triggered electromyography and spinal cord function with reflexes and f-responses. J Clin Monit Comput 19:437–461

    PubMed  Google Scholar 

  • Liem L K (2016) Intraoperative neurophysiological monitoring: overview, history, Electromyography. Medscape. https://emedicine.medscape.com/article/1137763-overview#a2. Accessed 21 April 2018

  • MacDonald DB, Skinner S, Shils J, Yingling C (2013) Intraoperative motor evoked potential monitoring – a position statement by the American Society of Neurophysiological Monitoring. J Clin Neurophysiol 124:2291–2316

    CAS  Google Scholar 

  • Macdonald DB, Al-Enazi M, Zayed A-Z (2015) Vertebral column surgery. In: Barry B (ed) A practical approach to neurophysiologic intraoperative monitoring, 2nd edn. Demos Medical, New York, pp 87–105

    Google Scholar 

  • Mergos J, Kale EB, Husain AM (2015) Training curriculum for NIOM. In: Barry B (ed) A practical approach to neurophysiologic intraoperative monitoring, 2nd edn. Demos Medical, New York, pp 334–353

    Google Scholar 

  • Merton PA, Morton HB (1980) Stimulation of the cerebral cortex in the intact human subject. Nature 285:227

    CAS  PubMed  Google Scholar 

  • Minahan RE, Riley LH, Lukaczyk T, Cohen DB, Kostuik JP (2000) The effect of neuromuscular blockade on pedicle screw stimulation thresholds. Spine 25:2526–2530

    CAS  PubMed  Google Scholar 

  • Neira VM, Ghaffari K, Bulusu S, Moroz P, Jarvis JG, Barrowman N, Splinter W (2016) Anesth Analg 123:1556–1566

    PubMed  Google Scholar 

  • Nichols GS, Manafov E (2012) Utility of electromyography for nerve root monitoring during spinal surgery. J Clin Neurophysiol 29:140–148

    PubMed  Google Scholar 

  • Nuwer MR (2008) Intraoperative monitoring of neural function. Elsevier, Amsterdam

    Google Scholar 

  • Nuwer MR (2015) Coding, billing and ethical issues. In: Barry B (ed) A practical approach to neurophysiologic intraoperative monitoring, 2nd edn. Demos Medical, New York, pp 363–367

    Google Scholar 

  • Nuwer MR, Packwood JW (2008) Chapter 11: somatosensory evoked potential monitoring with scalp and cervical recording. In: Nuwer MR (ed) Intraoperative monitoring of neural function: handbook of clinical neurophysiology, vol 8. Elsevier, Amsterdam, pp 180–189

    Google Scholar 

  • Nuwer MR, Emerson RG, Galloway G, Legatt AD, Lopez J, Minahan R, Yamada T, Goodin DS, Armon C, Chaudhry V, Gronseth GS, Harden CL (2012) Evidence-based guideline update: intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials. J Clin Neurophysiol 29:101–108

    PubMed  Google Scholar 

  • Prielipp RC, Morell RC, Walker FO, Santos CC, Bennet J, Butterworth J (1999) Ulnar nerve pressure. Anesthesiology 91:345–354

    CAS  PubMed  Google Scholar 

  • Reaz MBI, Hussain MS, Mohd-Yasin F (2006) Techniques of EMG signal analysis: detection, processing, classification and applications. Biol Proced Online 8:11–35

    Google Scholar 

  • Rose RD, Welch WC, Balzer JR, Jacobs GB (1997) Persistently electrified pedicle stimulation instruments in spinal instrumentation. Technique and protocol development. Spine 22:334–343

    CAS  PubMed  Google Scholar 

  • Skinner SA, Rippe DM (2012) Threshold testing of lumbosacral pedicle screws: a reappraisal. J Clin Neurophysiol 29:493–501

    PubMed  Google Scholar 

  • Slimp JC, Holdefer RN (2014) Chapter 36: somatosensory evoked potentials: an electrophysiological tool for intraoperative monitoring. In: Intraoperative neuromonitoring, 1st edn. McGraw-Hill Education, China, pp 405–423

    Google Scholar 

  • Sloan TB, Jäntti V (2008) Anesthetic effects on evoked potentials. In: Nuwer MR (ed) Intraoperative monitoring of neural function: handbook of clinical neurophysiology, vol 8. Elsevier, Amsterdam, pp 94–126

    Google Scholar 

  • Tamaki T, Kubota S (2007) History of the development of intraoperative spinal cord monitoring. J Eur Spine 16:S140–S146

    Google Scholar 

  • Tamkus AA, Rice KS, McCaffrey MT (2017) Perils of intraoperative neurophysiological monitoring: analysis of “false-negative” results in spine surgeries. Spine J 18:276–284

    PubMed  Google Scholar 

  • Vitale MG, Skaggs DL, Pace GI, Wright ML, Matsumoto H, Anderson RCE, Brockmeyer DL, Dormans JP, Emans JB, Erickson MA, Flynn JM, GLotzbecker MP, Ibrahim KN, Lewis SJ, Luhmann SJ, Mendiratta A, Richards BS, Sanders JO, Shah SA, Smith JT, Song KM, Sponseller PD, Sucato DJ, Roye DP, Lenke LG (2018) Best practices in intraoperative neuromonitoring in spine deformity surgery: development of and intraoperative checklist to optimize response. Spine Deform 2:333–339

    Google Scholar 

  • Vodušesk DB, Deletis V (2002) Intraoperative neurophysiological monitoring of the sacral nervous system. In: Deletis V, Shils J (eds) Neurophysiology in neurosurgery: a modern intraoperative approach, 1st edn. Elsevier Science, California, pp 197–217

    Google Scholar 

  • Ziewacz JE, Berven SH, Mummaneni VP, Tu T, Akinbo OC, Lyon R, Mummaneni PV (2012) The design, development, and implementation of a checklist for intraoperative neuromonitoring changes. Neurosurg Focus 33:1–10

    Google Scholar 

  • Zuccaro M, Zuccaro J, Samdani AF, Pahys JM, Hwang SW (2017) Intraoperative neuromonitoring alerts in a pediatric deformity center. Neurosurg Focus 43:1–7

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Kinesiology, University of Michigan, Ann Arbor, MI, USA

    Julian Michael Moore

  2. Department of Neurology, University of Michigan, Ann Arbor, MI, USA

    Julian Michael Moore

Authors
  1. Julian Michael Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Julian Michael Moore .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Allegheny General Hospital Department of Neurosurgery, Mars, PA, USA

    Boyle Cheng

Section Editor information

  1. Department of Orthopaedic Surgery, University of Missouri Health Care, Columbia, OH, USA

    Don K. Moore

  2. Dept. of Neurosurgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA, USA

    William C. Welch

  3. Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States

    William C. Welch

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Moore, J.M. (2020). Intraoperative Monitoring in Spine Surgery. In: Cheng, B. (eds) Handbook of Spine Technology. Springer, Cham. https://doi.org/10.1007/978-3-319-33037-2_128-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-33037-2_128-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-33037-2

  • Online ISBN: 978-3-319-33037-2

  • eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences

Publish with us

Policies and ethics

Search

Navigation