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Intraoperative Neurophysiology Monitoring

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Minimally Invasive Spine Surgery

Abstract

Intraoperative neurophysiology monitoring (IONM) provides valuable adjunctive information to the surgical team, enhancing their understanding of the patient’s anatomy with the goal of improving patient outcomes and reducing complications. This chapter discusses the roles of specific IONM modalities in minimally invasive spine surgery. The role of IONM in the placement of percutaneous pedicle screws and the far lateral approach to the lumbar spine are described.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of California San Diego Health System, San Diego, CA, USA

    Mihir Gupta

  2. Scrips Research Institute, Scripps Health, La Jolla, CA, USA

    Sandra E. Taylor

  3. Safeop Surgical, Inc., Hunt Valley, MD, USA

    Richard A. O’Brien

  4. Department of Neurosurgery, University of California San Diego, San Diego, CA, USA

    William R. Taylor & Laura Hein

Authors
  1. Mihir Gupta
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  2. Sandra E. Taylor
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  3. Richard A. O’Brien
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  4. William R. Taylor
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  5. Laura Hein
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Corresponding author

Correspondence to William R. Taylor .

Editor information

Editors and Affiliations

  1. Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Frank M. Phillips

  2. Texas Back Institute Texas Health Presbyterian Hospital Plano Scoliosis and Spine Tumor Center, Plano, TX, USA

    Isador H. Lieberman

  3. Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA

    David W. Polly Jr.

  4. Department of Neurological Surgery, University of Miami/Jackson Memorial Hospital, Miami, FL, USA

    Michael Y. Wang

Appendices

Quiz Questions

  1. 1.

    Peripheral/central structures generally benefit from TrEMG and recordings of SpEMG. Central/peripheral tracts at risk benefit most from SSEP and/or MEP monitoring.

  2. 2.

    Which of the following can lead to changes in SSEPs? (select all that apply)

    1. (a)

      Neural pathway compromise associated with patient positioning compression or stretch injuries

    2. (b)

      Halogenated anesthetic agents

    3. (c)

      Nitrous oxide

    4. (d)

      Hypothermia

    5. (e)

      Electrical interference

  3. 3.

    Which type of information is provided by SSEPs? (choose one)

    1. (a)

      Information about the particular nerve stimulated

    2. (b)

      Discrete segmental

    3. (c)

      Dermatomal information

    4. (d)

      Nerve root information

    5. (e)

      All of the above

  4. 4.

    SSEPs capture data from ascending/descending volleys, while MEP or transcranial MEP (TcMEP) captures data from ascending/descending volleys.

  5. 5.

    Which of the following are the benefits of using multimodality monitoring?

    1. (a)

      Multimodality monitoring broadens the structures being tested

    2. (b)

      Reduces the impact of false-negative results by recognizing the test with the highest sensitivity for a potential injury taking place

    3. (c)

      Provides redundancy when technical difficulties cause individual modalities to fail

    4. (d)

      All of the above

  6. 6.

    The use of both EMG and SSEP during complex lumbosacral spine surgeries is ideal due to the high sensitivity/specificity of EMG and the high sensitivity/specificity of SSEP

Answers

  1. 1.

    Peripheral structures generally benefit from TrEMG and recordings of SpEMG.

  •  Central tracts at risk benefit most from SSEP and/or MEP monitoring.

  1. 2.

    a, b, c, d, e

  2. 3.

    a

  3. 4.

    SSEPs capture data from ascending volleys, while MEP or transcranial MEP (TcMEP) captures data from descending volleys.

  4. 5.

    d

  5. 6.

    The use of both EMG and SSEP during complex lumbosacral spine surgeries is ideal due to the high sensitivity of EMG and the high specificity of SSEP.

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Gupta, M., Taylor, S.E., O’Brien, R.A., Taylor, W.R., Hein, L. (2019). Intraoperative Neurophysiology Monitoring. In: Phillips, F., Lieberman, I., Polly Jr., D., Wang, M. (eds) Minimally Invasive Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-19007-1_7

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  • DOI: https://doi.org/10.1007/978-3-030-19007-1_7

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  • Online ISBN: 978-3-030-19007-1

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