When to Use Neuromonitoring in Spine Surgery
By Admin | March 19, 2021
While many surgeons prefer using neuromonitoring for all spinal surgeries in an effort to reduce potential complications, controversies exist regarding its use in routine procedures because of its high cost, as well as its effectiveness.
History of Neuromonitoring
Neuromonitoring is a technology that allows the surgeon to assess spinal cord function during surgery through real-time feedback from individual nerve roots, motor tracts, and sensory tracts. After the introduction of the first commercial intraoperative neuromonitoring (IONM), the procedure became popular in the 1980s. However, the concept of electrical stimulation for the purpose of collecting data about the nervous system first arose in the 1930s.
Though technology was invented in Japan in 1972 that utilized the spinal cord evoked potential (SCEP) after direct stimulation of the spinal cord, in the United States, surgeons had to "rig" their own machines to collect this type of data, which was inefficient and often unwieldy. The introduction of the first IONM machine in the 1980s changed this landscape in the United Kingdom and United States.
All these methods monitored sensory mediated tracts in the spinal cord; but, at that time, the only way to monitor motor function was by using the “Wake up test” developed by Vauzelle and Stagnara (1973). In 1980, Merton and Morton reported a technology to stimulate the brain transcranially and opened the doors for motor tract monitoring.
In 1990, The American Society of Neurophysiological Monitoring was founded to serve the expanding IONM field. According to the society’s definition, IONM “includes any measure employed to assess the ongoing functional integrity of the central or peripheral nervous system in the operating theatre or other acute care setting.”
The multidisciplinary support of hardware and software development and the evolution of anesthesiology has not only made neuromonitoring possible in the...(More)
For more information please read, When to Use Neuromonitoring in Spine Surgery, by spineuniverse