• AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves Updated Position Statement: Intraoperative Electrophysiological Monitoring

    January 2018

    Intraoperative somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring are commonly referred to as intraoperative monitoring (IOM). There is Level I evidence that IOM is a reliable diagnostic tool for assessment of spinal cord integrity during surgery. MEPs have been shown to be superior to SSEPs in the assessment of spinal cord integrity during surgery. Intraoperative MEPs have been shown to predict recovery in traumatic cervical spinal cord injury.

    There is insufficient evidence (Level III) of a therapeutic benefit of IOM during spinal surgery. While IOM is generally regarded as integral to lateral spine surgery, there is insufficient evidence to support a therapeutic benefit. The cost-effectiveness of IOM has been inadequately studied.

    There is no published data to suggest that IOM results in alterations of procedures, abortion of procedures, increased procedure/anesthesia time, increased procedural difficulty, or increased risk of needle-sticks for the operative team.

    IOM should be performed in procedures when the operating surgeon feels that the diagnostic information is of value, such as deformity correction, spinal instability, spinal cord compression, intradural spinal cord lesions and when in proximity to peripheral nerves or roots. Spontaneous and evoked electromyography is recommended for minimally invasive lateral retroperitoneal transpsoas approaches to the lumbar spine, and may also be of utility during pedicle screw insertion.

    References:

    1) Resnick DK, Anderson PA, Choudhri T, Groff M, Heary R, Holly L, Ryken T, Vresilovik E, Matz PG: Guidelines for the management of cervical degenerative disease: Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy. Journal of Neurosurgery: Spine 11(2): 245-252, 2009

    2) Alok Sharan, M.D., Michael W. Groff, M.D., Andrew T. Dailey, M.D., Zoher Ghogawala, M.D., Daniel K. Resnick, M.D., William C. Watters III, M.D., Praveen V. Mummaneni, M.D., Tanvir F. Choudhri, M.D., Jason C. Eck, D.O., M.S., Jeffrey C. Wang, M.D., Sanjay S. Dhall, M.D., and Michael G. Kaiser, M.D: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: Electrophysiological monitoring and lumbar fusion. Journal of Neurosurgery: Spine Jul 2014 / Vol. 21 / No. 1, Pages 102-105

    3) Traynelis VC, Abode-Ivamah KO, Leick KM, Bender SM, Greenlee JD: Cervical decompression and reconstruction without intraoperative neurophysiological monitoring. J Neurosurg Spine 16(2):107-13, 2012

    4) Thirumala PD, Bodily L, Tint D, W. Ward T, Deeney VF, Crammond DJ, Habeych ME, Balzer JR. Somatosensory-evoked potential monitoring during instrumented scoliosis corrective procedures: validity revisited. The Spine J. epub 2013

    5) Kothbauer KF, Intraoperative neurophysiologic monitoring for intramedullary spinal-cord tumor surgery. Neurophysiologie Clinique/Clinical Neurophysiology 37(6), Pages 407–414, 2007

    6) Uribe JS, Vale FL, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine 2010; 35:S368–74.

    7) Dhall SS, Haefeli J, Talbott JF, Ferguson AR, Readdy WJ, Bresnahan JC, Beattie MS, Pan JZ, Manley GT, Whetstone WD. Motor Evoked Potentials Correlate With Magnetic Resonance Imaging and Early Recovery After Acute Spinal Cord Injury. Neurosurgery. 2017 Jul 7.

    8) Hadley MN, Shank CD, Rozzelle CJ, Walters BC.Guidelines for the Use of Electrophysiological Monitoring for Surgery of the Human Spinal Column and Spinal Cord. Neurosurgery. 2017 Nov 1; 81(5):713-732.

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