The effect of intraoperative neurophysiological monitoring on neurological outcomes after spinal tumors operations: A single institution experience

Abstract

We aim to report our study about using multimodality intraoperative neurophysiological monitoring (IONM) in intradural spinal tumor surgery. This cohort present a retrospective review of the patient who underwent intraspinal tumors surgery at Vajira Center of Excellence in Neurosurgery; between 2005 and 2020. Transcranial motor evoked potentials, somatosensory evoked potentials, and free run electromyography were used for IONM with alarm criteria. Patient record were reviews with preoperative and postoperative neurological outcome measurements; Frankel Grading, McCormick Score, American Spinal Injury Association (ASIA) Grading, Karnofsky Performance Status (KPS) Scale and The Japanese Orthopedic Association (JOA) Score at 1, 6, 12, 24 months after operation. Overall, 104 patients were operated. 77.4 % operations were used IONM. 70.2 % of tumor located at intradural extramedullary (IDEM) space and 16.7 % located at intramedullary space. There were demonstrating statistically significant (p-value < 0.050) improvement between preoperative and postoperative neurological outcome in all follow up time in IONM group. The sensitivity and specificity of alarm IONM to predict early worsening postoperative neurological outcome were 66.7 % and 88.7 %, respectively. IDEM spinal cord tumor surgery are associated with good neurological outcome (OR 0.187 [95 % CI 0.05–0.71]; p-value 0.014). Used of IONM in intradural spinal tumor surgery statistically significant improved postoperative neurological outcome and decrease postoperative neurological deficit. IONM has ability to detect postoperative neurological deficit and poor outcome with fair sensitivity and high specificity. Especially, using of IONM in IDEM have preferable postoperative neurological outcomes.