title: Intraoperative Neurophysiological Monitoring in Spine Surgery: A Significant Tool for Neuronal Protection and Functional Restoration.
abstract: Although there is recent evidence for the role of intraoperative neurophysiological monitoring (IONM) in spine surgery, there are no uniform opinions on the optimal combination of the different tools. At our institution, multimodal IONM (mIONM) approach in spine surgery involves the evaluation of somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) with electrical transcranial stimulation, including the use of a multipulse technique with multiple myomeric registration of responses from limbs, and a single-pulse technique with D-wave registration through epi- and intradural recording, and free running and evoked electromyography (frEMG and eEMG) with bilateral recording from segmental target muscles. We analyzed the impact of the mIONM on the preservation of neuronal structures and on functional restoration in a prospective series of patients who underwent spine surgery. We observed an improvement of neurological status in 50 % of the patients. The D-wave registration was the most useful intraoperative tool, especially when MEP and SEP responses were absent or poorly recordable. Our preliminary data confirm that mIONM plays a fundamental role in the identification and functional preservation of the spinal cord and nerve roots. It is highly sensitive and specific for detecting and avoiding neurological injury during spine surgery and represents a helpful tool for achieving optimal postoperative functional outcome.
authors.affiliation: Department of Neurosurgery, University of Messina, Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Scibilia
authors.affiliation: Neurosurgery and Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Raffa
authors.affiliation: Neurology, University of Messina, Consolare Valeria 1, Messina, 98125, Italy. enzo.rizzo@gmail.com.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Rizzo
authors.affiliation: Neurology, University of Messina, Messina, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Quartarone
authors.affiliation: Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.affiliation: Department of Neurosurgery, University of Messina, Messina, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Germanò
authors.affiliation: Department of Neurosurgery, University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tomasello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004576:Electromyography; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009436:Neural Tube Defects / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies; D013120:Spinal Cord Neoplasms / Q000601:surgery*; D065908:Transcranial Direct Current Stimulation; D055815:Young Adult
keywords: Functional outcome; Intraoperative neurophysiological monitoring; Multimodal IONM; Spine surgery