title: Intraoperative neurophysiological monitoring in spinal surgery.
abstract: Recently, many surgeons have been using intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials (MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.
authors.affiliation: Jong-Hwa Park, Seung-Jae Hyun, Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Gyeonggi, South Korea.
authors.forename: Jong-Hwa
authors.initials: JH
authors.lastname: Park
authors.affiliation: Jong-Hwa Park, Seung-Jae Hyun, Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Gyeonggi, South Korea.
authors.forename: Seung-Jae
authors.initials: SJ
authors.lastname: Hyun
keywords: Direct wave; Intraoperative neurophysiological monitoring; Motor-evoked potentials; Somatosensory-evoked potentials; Spinal surgery