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World J Clin Cases. Sep 16, 2015; 3(9): 765-773
Published online Sep 16, 2015. doi: 10.12998/wjcc.v3.i9.765
Intraoperative neurophysiological monitoring in spinal surgery
Jong-Hwa Park, Seung-Jae Hyun
Jong-Hwa Park, Seung-Jae Hyun, Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 463-707, Gyeonggi, South Korea
Author contributions: Both authors contributed to this manuscript.
Conflict-of-interest statement: The authors have no personal financial or institutional interests in any of the drugs, materials or devices described in this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Seung-Jae Hyun, MD, PhD, Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82, Gumi-ro 173 Beon-Gil, Bundang, Seongnam 463-707, Gyeonggi, South Korea. hyunsj@snu.ac.kr
Telephone: +82-31-7877164 Fax: +82-31-7874097
Received: September 24, 2014
Peer-review started: September 24, 2014
First decision: October 28, 2014
Revised: May 24, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: September 16, 2015
Processing time: 356 Days and 9.3 Hours
Abstract

Recently, many surgeons have been using intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and combined motor and somatosensory evoked potentials are considered mandatory for practical and successful IOM. Spinal cord evoked potentials are elicited compound potentials recorded over the spinal cord. Electrical stimulation is provoked on the dorsal spinal cord from an epidural electrode. Somatosensory evoked potentials assess the functional integrity of sensory pathways from the peripheral nerve through the dorsal column and to the sensory cortex. For identification of the physiological midline, the dorsal column mapping technique can be used. It is helpful for reducing the postoperative morbidity associated with dorsal column dysfunction when distortion of the normal spinal cord anatomy caused by an intramedullary cord lesion results in confusion in localizing the midline for the myelotomy. Motor evoked potentials (MEPs) consist of spinal, neurogenic and muscle MEPs. MEPs allow selective and specific assessment of the functional integrity of descending motor pathways, from the motor cortex to peripheral muscles. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome.

Keywords: Motor-evoked potentials; Somatosensory-evoked potentials; Intraoperative neurophysiological monitoring; Direct wave; Spinal surgery

Core tip: Recently, many surgeons have used intraoperative neurophysiological monitoring (IOM) in spinal surgery to reduce the incidence of postoperative neurological complications, including level of the spinal cord, cauda equina and nerve root. Several established technologies are available and multimodality combinations are considered necessary for practical and effective IOM. Spinal surgeons should understand the concept of the monitoring techniques and interpret monitoring records adequately to use IOM for the decision making during the surgery for safe surgery and a favorable surgical outcome. In this review, the authors will review the different IOM techniques to provide a fundamental concept for better comprehension.