Monitoring Procedures of the Spine

  • Denise A. Birkholz
  • Scott Francis Davis


The vertebral column is an extremely complex structure, and surgical procedures involving cervical, thoracic, and lumbar levels pose a risk to the neural elements. Although the overall incidence of a major neurologic complication such as paraplegia is low, advances in intraoperative neurophysiological monitoring (IONM) techniques have made multimodality monitoring an effective approach for preventing iatrogenic injury to the nervous system during spinal surgery.


Spine Ischemia Osteoporosis Cage Neuropathy 


  1. 1.
    Currier B. Neurological complications of cervical spine surgery: C5 palsy and intraoperative monitoring. Spine (Phila Pa 1976). 2012;37(5):E328–34.CrossRefGoogle Scholar
  2. 2.
    Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. C5 palsy after decompression surgery for cervical myelopathy: review of the literature. Spine (Phila Pa 1976). 2003;28(21):2447–51.CrossRefGoogle Scholar
  3. 3.
    Uribe JS, Kolla J, Omar H, Dakwar E, Abel N, Mangar D, et al. Brachial plexus injury following spinal surgery. J Neurosurg Spine. 2010;13:552–8.CrossRefGoogle Scholar
  4. 4.
    Beutler WJ, Sweeney CA, Connolly PJ. Recurrent laryngeal nerve injury with anterior cervical spine surgery risk with laterality surgical approach. Spine (Phila Pa 1776). 2001;26(12):1337–42.CrossRefGoogle Scholar
  5. 5.
    Dimopoulos VG, Chung I, Lee GP, Johnston KW, Kapsalakis IZ, Smisson HF 3rd, et al. Quantitative estimation of the recurrent laryngeal nerve irritation by employing spontaneous intraoperative electromyographic monitoring during anterior cervical discectomy and fusion. J Spinal Disord Tech. 2009;22(1):1–7.CrossRefGoogle Scholar
  6. 6.
    Ebraheim N. Posterior lateral mass screw fixation: anatomic and radiographic considerations. Univ Penn Orthop J. 1999;12:66–72.Google Scholar
  7. 7.
    Mohamed E, Ihab Z, Moaz A, Ayman N, Haitham AE. Lateral mass fixation in subaxial cervical spine: anatomic review. Global Spine J. 2012;2:39–46.CrossRefGoogle Scholar
  8. 8.
    Khan MH, Smith PN, Balzer JR, Crammond D, Welch WC, Gerszten P, et al. Intraoperative somatosensory evoked potential monitoring during cervical spine corpectomy surgery: experience with 508 cases. Spine (Phila Pa 1976). 2006;31(4):E105–13.CrossRefGoogle Scholar
  9. 9.
    Good C. The genetic basis of idiopathic scoliosis. J Spinal Res Found. 2009;4(1):13–5.Google Scholar
  10. 10.
    Chung I, Glow JA, Dimopoulos V, Walid MS, Smisson HF, Johnston KW, et al. Upper-limb somatosensory evoked potential monitoring in lumbosacral spine surgery: a prognostic marker for position-related ulnar nerve injury. Spine J. 2009;9(4):287–95.CrossRefGoogle Scholar
  11. 11.
    Kamel IR, Drum ET, Koch SA, Whitten JA, Gaughan JP, Barnette RE, et al. The use of somatosensory evoked potentials to determine the relationship between patient positioning and impending upper extremity nerve injury during spine surgery: a retrospective analysis. Anesth Analg. 2006;102:1538–42.CrossRefGoogle Scholar
  12. 12.
    MacDonald DB, Al Zayed Z, Khoudeir I, Stigsby B. Monitoring scoliosis surgery with combined multiple pulse transcranial electric motor and cortical somatosensory-evoked potentials from the lower and upper extremities. Spine (Phila Pa 1976). 2003;28(2):194–203.CrossRefGoogle Scholar
  13. 13.
    Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine. 1983;9(8):817–31.CrossRefGoogle Scholar
  14. 14.
    Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3:184–201.CrossRefGoogle Scholar
  15. 15.
    Parker SL, Amin AG, Farber SH, McGirt MJ, Sciubba DM, Wolinsky JP, et al. Ability of electromyographic monitoring to determine the presence of malpositioned pedicle screws in the lumbosacral spine: analysis of 2450 consecutively placed screws. J Neuosurg Spine. 2011;15:130–5.CrossRefGoogle Scholar
  16. 16.
    Raynor BL, Lenke LG, Bridwell KH, Taylor BA, Padberg AM. Correlation between low triggered electromyographic thresholds and lumbar pedicle screw malposition: analysis of 4857 screws. Spine (Phila Pa 1976). 2007;32(24):2673–8.CrossRefGoogle Scholar
  17. 17.
    Isley MR, Zhang XF, Balzer JR, Leppanen RE. Current trends in pedicle screw stimulation techniques: lumbosacral, thoracic, and cervical levels. Neurodiagn J. 2012;52:100–75.PubMedGoogle Scholar
  18. 18.
    Anderson DG, Wierzbowski LR, Schwartz DM, Hilibrand AS, Vaccaro AR, Albert TJ. Pedicle screws with high electrical resistance: a potential source of error with stimulus-evoked EMG. Spine (Phila Pa 1976). 2002;27(14):1577–81.CrossRefGoogle Scholar
  19. 19.
    Brau SA, Spoonamore MJ, Snyder L, Gilbert C, Rhonda G, Williams LA, et al. Nerve monitoring changes related to iliac artery compression during anterior lumbar spine surgery. Spine J. 2003;3(5):351–5.CrossRefGoogle Scholar
  20. 20.
    Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP Jr. Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine (Phila Pa 1976). 2007;32(24):2751–8.CrossRefGoogle Scholar
  21. 21.
    Lall RR, Hauptman JS, Munoz C, Cybulski GR, Koski T, et al. Intraoperative neurophysiologcal monitoring in the spine: indications, efficacy, and role of the preoperative checklist. Neurosurg Focus. 2012;33(5):E10.CrossRefGoogle Scholar
  22. 22.
    Anand N, Baron EM, Thaiyananthan G, Khalsa K, Goldstein TB. Minimally invasive multilevel percutaneous correction and fusion for adult lumbar degenerative scoliosis a technique and feasibility study. J Spinal Disord Tech. 2008;21(7):459–67.CrossRefGoogle Scholar
  23. 23.
    Woods KR, Billys JB, Hynes RA. Technical description of oblique lateral interbody fusion at L1-L5 (OLIF25) and at L5-S1 (OLIF51) and evaluation of complication and fusion rate. Spine J. 2017;17(4):545–53.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Denise A. Birkholz
    • 1
  • Scott Francis Davis
    • 2
  1. 1.Neuromonitoring Associates, LLCLas VegasUSA
  2. 2.Department of AnesthesiologyLouisiana State University School of Medicine, Tulane University School of MedicineNew OrleansUSA

Personalised recommendations