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Meta-Analysis
. 2018 Aug;43(16):1154-1160.
doi: 10.1097/BRS.0000000000002575.

Intraoperative Neurophysiological Monitoring in Spine Surgery: A Systematic Review and Meta-Analysis

Jefferson Walter Daniel  1 , Ricardo Vieira Botelho  2 , Jerônimo Buzetti Milano  3 , Fernando Rolemberg Dantas  4 , Franz Jooji Onishi  5 , Eloy Rusafa Neto  6 , Eduardo de Freitas Bertolini  2 , Marcelo Antonio Duva Borgheresi  7 , Andrei Fernandes Joaquim  8   9
Affiliations
Meta-Analysis

Intraoperative Neurophysiological Monitoring in Spine Surgery: A Systematic Review and Meta-Analysis

Jefferson Walter Daniel et al. Spine (Phila Pa 1976). 2018 Aug.

Abstract

Study design: Systematic literature review and meta-analysis.

Objective: The objective of this systematic literature review was to evaluate if intraoperative neurophysiological monitoring (IONM) can prevent neurological injury during spinal operative surgical procedures.

Summary of background data: IONM seems to have presumable positive effects in identifying neurological deficits. However, the role of IONM in the decrease of new neurological deficits remains unclear.

Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and Meta-analysis, we reviewed clinical comparative studies who evaluate the rate of new neurological events in patients who had a spinal surgery with and without IONM. Studies were then classified according to their level of evidence. Methodological quality was assessed according to methodological index for non-randomized studies instrument.

Results: Six studies were evaluated comparing neurological events with and without IONM use by the random effects model. There was a great statistical heterogeneity. The pooled odds ratio (OR) was 0.72 {0.71; 1.79}, P = 0.4584. A specific analysis was done for two studies reporting the results of IONM for spinal surgery of intramedullary lesions. The OR was 0.1993 (0.0384; 1.0350), P = 0.0550.

Conclusion: IONM did not result into fewer neurological events with the obtained evidence of the included studies. For intramedullary lesions, there was a trend to fewer neurological events in patients who underwent surgery with IONM. Further prospective randomized studies are necessary to clarify the indications of IONM in spinal surgeries.

Level of evidence: 2.

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Comment in

  • Letters.
    Gonzalez AA, Cheongsiatmoy J, Shilian P, Parikh P. Gonzalez AA, et al. Spine (Phila Pa 1976). 2018 Jul 1;43(13):E796. doi: 10.1097/BRS.0000000000002698. Spine (Phila Pa 1976). 2018. PMID: 29894430 No abstract available.
  • TO THE EDITOR.
    Daniel JW, Botelho RV, Buzetti JM, Dantas FR, Onishi F, Neto ER, Bertolini EF, Borgheresi MD, Joaquim AF. Daniel JW, et al. Spine (Phila Pa 1976). 2018 Jul 1;43(13):E796-E797. doi: 10.1097/BRS.0000000000002699. Spine (Phila Pa 1976). 2018. PMID: 29894431 No abstract available.

References

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    1. Fehlings MG, Brodke DS, Norvell DC, et al. The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine (Phila Pa 1976) 2010; 35 (Suppl):S37–S46.
    1. Gunnarsson T, Krassioukov AV, Sarjeant R, et al. Real-time continuous intraoperative electromyographic and somatosensory evoked potential recordings in spinal surgery: correlation of clinical and electrophysiologic findings in a prospective, consecutive series of 213 cases. Spine (Phila Pa 1976) 2004; 29:677–684.

MeSH terms