title: Surgeon-driven neurophysiologic monitoring in a spinal surgery population.
abstract: BACKGROUND
  This is a prospective observational study examining the use of a surgeon-driven intraoperative neurophysiologic monitoring system. Intraoperative neurophysiologic monitoring is becoming the standard of care for spinal surgeries with potential post-operative neurologic deficits. This standard applies to both adult and pediatric spinal surgery, but a shortage of appropriately trained and certified technologists and physiologists can compromise monitoring capabilities in some centers. A surgeon-driven, intra-operative monitoring system in the absence of a technologist or physiologist was examined for safety and efficacy.
  
  
  METHODS
  One hundred thirty-five patients undergoing a variety of spinal procedures were monitored intra-operatively using a surgeon-driven neuro-monitoring system over a period of 80 months. Intraoperative monitoring included serial motor evoked potentials via an automated system that provided visual and audible feedback directly to the operative surgeon. Changes in monitoring and any corresponding surgical responses were evaluated and compared with postoperative neurological status.
  
  
  RESULTS
  Of the 135 patients studied, intraoperative adjustments based on neuro-monitoring took place in four patients (3.0%): following reduction in spondylolisthesis, during instrumentation and fusion for a large kyphoscoliosis deformity, due to low hemoglobin, and because of traction. In all cases, surgical and/or anaesthetic modification restored MEPs toward baseline values. The accuracy of the neuro-monitoring results was sensitive to narcotics, benzodiazepines and changes in haemoglobin concentrations. No new postoperative deficits were observed in any patients in the cohort.
  
  
  CONCLUSIONS
  The authors concluded that surgeon-driven neuro-monitoring was a safe and effective means of intraoperative neuro-monitoring during spinal surgery. It reliably detected intraoperative insults, which could potentially have resulted in postoperative neurologic compromise, and was not associated with any false-negative results in this cohort. Utility of surgeon-driven monitoring, using validated algorithms, may provide an option for this added safety measure even in cases where monitoring personnel are unavailable.
authors.affiliation: Department of Surgery, Queen's University, Kingston, Ontario, K7L 2V7, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Pickell
authors.affiliation: Department of Surgery, Queen's University, Kingston, Ontario, K7L 2V7, Canada.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Mann
authors.affiliation: Trillium Health Center, 100 Queensway W, Mississauga, Ontario L5B 1B8, Canada.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chakravertty
authors.affiliation: Department of Surgery, Queen's University, Kingston, Ontario, K7L 2V7, Canada.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Borschneck
keywords: Neurophysiologic; evoked potentials; intraoperative; monitoring; somatosensory; spine