title: Neurophysiological monitoring and spinal cord integrity.
abstract: An integral part of a major spine surgery is the intraoperative neurophysiological monitoring (IONM). By providing continuous functional assessment of specific anatomic structures, IONM allows the rapid detection of neuronal compromise and the opportunity for corrective action before an insult causes permanent neurological damage. Thus, IONM functions not just as a diagnostic tool but may also improve surgical outcomes. Effective clinical application requires a thorough understanding of the scope and limitations of IONM modalities not only by the monitoring team but also by the surgeon and anesthesiologist. Intraoperatively, collaboration and communication between monitorist, surgeon, and anesthesiologist are critical to the effectiveness of IONM. In this study, we review specific monitoring modalities, focusing on the relevant anatomy, physiology, and mechanisms of neuronal injury during major spine surgery. We discuss how these factors interact with anesthetic and surgical management. This review concludes with the current controversies surrounding the evidence in support of IONM and directions of future research.
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254 JHMHSC, 1600 SW Archer Rd., Room M-509, Gainesville, FL 32610-0254, USA. Electronic address: frabai@anest.ufl.edu.
authors.forename: Ferenc
authors.initials: F
authors.lastname: Rabai
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254 JHMHSC, 1600 SW Archer Rd., Room M-509, Gainesville, FL 32610-0254, USA. Electronic address: rsessions@anest.ufl.edu.
authors.forename: Renard
authors.initials: R
authors.lastname: Sessions
authors.affiliation: Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254 JHMHSC, 1600 SW Archer Rd., Room M-509, Gainesville, FL 32610-0254, USA. Electronic address: cseubert@anest.ufl.edu.
authors.forename: Christoph N
authors.initials: CN
authors.lastname: Seubert
mesh_terms: D000758:Anesthesia / Q000379:methods; D003142:Communication; D003299:Cooperative Behavior; D006801:Humans; D016343:Monitoring, Intraoperative / Q000379:methods; D064926:Neurophysiological Monitoring / Q000379:methods*; D013116:Spinal Cord; D013119:Spinal Cord Injuries / Q000517:prevention & control; D013131:Spine / Q000601:surgery*
keywords: electromyography; inhalational anesthetics; intraoperative neuromonitoring; intravenous anesthetics; major spine surgery; motor evoked potentials; somatosensory evoked potentials; spinal cord integrity