Technique and advantages of multimodal intraoperative neuromonitoring for complex spinal interventions in older patients

Abstract

Complex spinal surgery in elderly patients mostly treats degenerative spine alterations. The use of multimodal intraoperative neuromonitoring (IONM) has proven to be auseful tool to recognize neural deterioration during such operations. Elderly patients often have preexisting neural impairment, which leads to difficulties in deriving some potentials or can even lead to not obtaining any potentials at all. For reliable benefits from IONM acombined use of monitoring and mapping methods as well as the right choice of methods according to the spine level to be treated and adefinition of the neural structures in danger is needed. This article intends to explain IONM methods in procedures treating degenerative spine alterations in acomprehensive way and to show our point of view on pedicle stimulation. Readers should be motivated to deepen their knowledge in these methods and to gain confidence and experience to increase the safety of these operations for the benefit of our patients.