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European Spine Journal
Published in: European Spine Journal 3/2019

01-03-2019 | Original Article

The impact and value of uni- and multimodal intraoperative neurophysiological monitoring (IONM) on neurological complications during spine surgery: a prospective study of 2728 patients

Authors: Martin Sutter, Andreas Eggspuehler, Dezsoe Jeszenszky, Frank Kleinstueck, Tamàs F. Fekete, Daniel Haschtmann, François Porchet, Jiri Dvorak

Published in: European Spine Journal | Issue 3/2019

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Abstract

Purpose

We compared the value of different uni- and multimodal intraoperative neurophysiological monitoring (IONM) methods on the detection of neurological complications during spine surgery.

Methods

IONM data derived from sensory spinal and cortical evoked potentials combined with continuous electromyography monitoring, motor evoked potentials and spinal recording were evaluated in relation to subsequent post-operative neurological changes. Patients were categorised based on their true-positive or true-negative post-operative neurological status.

Results

In 2728 consecutive patients we had 909 (33.3%) IONM alerts. We had 8 false negatives (0.3%) with post-operative radicular deficit that completely recovered within 3 months, except for one. There was no false negative for spinal cord injury. 107 were true positives, and 23 were false positives. Multimodal IONM sensitivity and specificity were 93.0% and 99.1%, respectively. The frequency of neurological complications including minor deficits was 4.2% (n = 115), of which 0.37% (n = 10) were permanent. Analysis of the single IONM modalities varied between 13 and 81% to detect neurological complications compared with 93% when using all modalities.

Conclusion

Multimodal IONM is more effective and accurate in assessing spinal cord and nerve root function during spine surgeries to reduce both neurological complications and false-negative findings compared to unimodal monitoring. We recommend multimodal IONM in all complex spine surgeries.

Graphical abstract

These slides can be retrieved from Electronic Supplementary Material.
Appendix
Available only for authorised users
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Metadata
Title
The impact and value of uni- and multimodal intraoperative neurophysiological monitoring (IONM) on neurological complications during spine surgery: a prospective study of 2728 patients
Authors
Martin Sutter
Andreas Eggspuehler
Dezsoe Jeszenszky
Frank Kleinstueck
Tamàs F. Fekete
Daniel Haschtmann
François Porchet
Jiri Dvorak
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
European Spine Journal / Issue 3/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-018-5861-0

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