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Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views

In spine deformity surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres...

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Autores principales: Biscevic, Mirza, Sehic, Aida, Krupic, Ferid
Formato: Online Artículo Texto
Lenguaje:English
Publicado: British Editorial Society of Bone and Joint Surgery 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017597/
https://www.ncbi.nlm.nih.gov/pubmed/32071769
http://dx.doi.org/10.1302/2058-5241.5.180032
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author Biscevic, Mirza
Sehic, Aida
Krupic, Ferid
author_facet Biscevic, Mirza
Sehic, Aida
Krupic, Ferid
author_sort Biscevic, Mirza
collection PubMed
description In spine deformity surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres. Prompt reaction within the reversible phase (reducing of compressive/distractive forces) usually restores functionality of the spinal cord, but if those forces continue to persist, a permanent neurological deficit might be expected. With monitoring of sensory pathways (dorsal column–medial lemniscus) by somatosensory-evoked potentials (SSEPs), such events are detected with a sensitivity of up to 92%, and a specificity of up to 100%. The monitoring of motor pathways by transcranial electric motor-evoked potentials (TceMEPs) has a sensitivity and a specificity of up to 100%, but it requires avoidance of halogenated anaesthetics and neuromuscular blockades. Different modalities of intraoperative neuromonitoring (IONM: SSEP, TceMEP, or combined) can be performed by the neurophysiologist, the technician or the surgeon. Combined SSEP/TceMEP performed by the neurophysiologist in the operating room is the preferable method of IONM, but it might be impractical or unaffordable in many institutions. Still, many spine deformity surgeries worldwide are performed without any type of IONM. Medicolegal aspects of IONM are different worldwide and in many cases some vagueness remains. The type of IONM that a spinal surgeon employs should be reliable, affordable, practical, and recognized by the medicolegal guidelines. Cite this article: EFORT Open Rev 2020;5:9-16. DOI: 10.1302/2058-5241.5.180032
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spelling pubmed-70175972020-02-18 Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views Biscevic, Mirza Sehic, Aida Krupic, Ferid EFORT Open Rev Spine In spine deformity surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres. Prompt reaction within the reversible phase (reducing of compressive/distractive forces) usually restores functionality of the spinal cord, but if those forces continue to persist, a permanent neurological deficit might be expected. With monitoring of sensory pathways (dorsal column–medial lemniscus) by somatosensory-evoked potentials (SSEPs), such events are detected with a sensitivity of up to 92%, and a specificity of up to 100%. The monitoring of motor pathways by transcranial electric motor-evoked potentials (TceMEPs) has a sensitivity and a specificity of up to 100%, but it requires avoidance of halogenated anaesthetics and neuromuscular blockades. Different modalities of intraoperative neuromonitoring (IONM: SSEP, TceMEP, or combined) can be performed by the neurophysiologist, the technician or the surgeon. Combined SSEP/TceMEP performed by the neurophysiologist in the operating room is the preferable method of IONM, but it might be impractical or unaffordable in many institutions. Still, many spine deformity surgeries worldwide are performed without any type of IONM. Medicolegal aspects of IONM are different worldwide and in many cases some vagueness remains. The type of IONM that a spinal surgeon employs should be reliable, affordable, practical, and recognized by the medicolegal guidelines. Cite this article: EFORT Open Rev 2020;5:9-16. DOI: 10.1302/2058-5241.5.180032 British Editorial Society of Bone and Joint Surgery 2020-01-29 /pmc/articles/PMC7017597/ /pubmed/32071769 http://dx.doi.org/10.1302/2058-5241.5.180032 Text en © 2020 The author(s) https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.
spellingShingle Spine
Biscevic, Mirza
Sehic, Aida
Krupic, Ferid
Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views
title Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views
title_full Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views
title_fullStr Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views
title_full_unstemmed Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views
title_short Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views
title_sort intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues – surgeons’ views
topic Spine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7017597/
https://www.ncbi.nlm.nih.gov/pubmed/32071769
http://dx.doi.org/10.1302/2058-5241.5.180032
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