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- Title
Intraoperative neurophysiological monitoring during spinal surgery: technical review in open and minimally invasive approaches.
- Authors
Cofano, Fabio; Zenga, Francesco; Mammi, Marco; Altieri, Roberto; Marengo, Nicola; Ajello, Marco; Pacca, Paolo; Melcarne, Antonio; Junemann, Carola; Ducati, Alessandro; Garbossa, Diego
- Abstract
Neurophysiological monitoring is of undoubted value for the intraoperative safety of neurosurgical procedures. Widely developed and used for cranial surgery, it is equally as effective, though perhaps less commonly employed, for spinal pathology. The most frequently used techniques for intraoperative monitoring during spinal surgery include somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs) and electromyography, which can either be spontaneous free-running (sEMG) or triggered (tEMG). The knowledge of the benefits and limitations of each modality is essential in optimising the value of intraoperative monitoring during spinal procedures. This review will analyse the single techniques, their anatomical and physiological basis, their use in spinal surgery as reliable indicators of functional injury, their limits and their application to specific procedures in minimally invasive surgery, such as the lateral transpsoas access for interbody fusion and the divergent trajectory for cortico-pedicular screws. In these particular techniques, because of reduced visual exposure, neuromonitoring is indeed essential to exploit the full potential of minimally invasive surgery, while avoiding damage to nervous structures.
- Subjects
NEUROPHYSIOLOGIC monitoring; SPINAL surgery; INTRAOPERATIVE monitoring; MINIMALLY invasive procedures; SOMATOSENSORY evoked potentials; PATHOLOGY
- Publication
Neurosurgical Review, 2019, Vol 42, Issue 2, p297
- ISSN
0344-5607
- Publication type
Article
- DOI
10.1007/s10143-017-0939-4