SY5.6. Intraoperative neurophysiological monitoring in cervical spine surgery

Abstract

Intraoperative monitoring (IOM) has been utilized for surgery of degenerative, neoplastic and traumatic causes of cervical spine disease. However, controversy still exits with regards to its clinical efficacy. Most studies to date have analyzed spinal or scoliosis surgery, while few focusing solely on cervical decompression are available. Early studies have described good sensitivity and specificity in the IOM of cervical spondylosis surgery with (Kim et al., 2007) or without myelopathy (Xu et al., 2011). However, this has been challenged by 2 subsequent ones which (Ajiboye et al., 2017, 2017) contradict the earlier findings. A systematic review conducted recently concluded that IOM is useful for detection of intraoperative neural damage in cervical spine surgery involving degenerative canal stenosis (de Martino et al., 2019). IOM has been reported to be efficacious for early identification of intraoperative C5 palsy after cervical myelopathy surgery, despite its rarity and cryptogenic nature. There is a current lack of systematic studies addressing IOM for cervical tumour surgery, and further research is needed. A recent study on motor evoked potentials (MEP) during IOM of cervical spondylotic myelopathy suggested that a 9 pulse stimulation train may be more efficacious than a 5 pulse train, whereby intraoperative improvement of MEP is more frequently observed in the former (Lo et al., 2020). The new findings may be relevant for future research into false positive and negatives during IOM of diseased spinal cords (Iorio et al., 2015; Lee et al., 2016).