Role of intraoperative neuromonitoring in spine surgery: A retrospective study

Abstract

Background: Iatrogenic neurological injury resulting during surgical intervention is a devastating complication not only for patient but also for the operating surgeon. Even with best efforts, the risk remains approximately 5%. Aims: This study aims to study the role of intraoperative neuromonitoring (IONM) in non-deformed spine surgeries and to find out the sensitivity and specificity. Settings and Design: Tertiary health-care centre. Retrospective study with data of the patients operated from January 2019 to January 2020 was reviewed and evaluated. Materials and Methods: Patients with spinal fractures, spondylodiscitis, bony tumours of spine and degenerative spinal disorders without neurological deficit were included. The patients with spinal deformity and with prior neurological deficits were excluded. Group A: the patients with no IONM signal drop during procedure, Group B: the patients who experienced significant drop in signal during surgery. Statistical Analysis Used: Data entry-MS Excel, Data analysis-SPSS 23.0 version for windows, descriptive statistics-mean ± numerical variable, null hypothesis-paired test-two sample for mean (<0.05 = significant). Results: Fifty-nine patients were included. Of 59, 50 patients had no significant drop, and 9 patients had permanent drop in signals. The mean blood loss in Group A was 735 ± 442.1 ml and was 978.9 ± 829 ml in Group B (P = 0.006). There was no signal drop in 39 patients. The sensitivity and specificity according to the above data in our series was 60% (confidence interval [CI] = 0.613–0.586) and 88% (CI = 0.891–0.886). Conclusions: IONM is fairly sensitive and very specific for detecting intraoperative neural compromise. There is significant correlation between the blood loss in the surgery and signal drop.

Keywords

• electromyography
• intraoperative neuromonitoring
• motor evoked potential