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Spine Surgery Basics pp 153–174Cite as

Neurological Monitoring in Orthopedic Spine Surgery

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Abstract

Intraoperative neurological monitoring (IOM) during spinal procedures is used to monitor spinal cord and nerve function and alert the surgeon to any compromise of such. It usually involves a combination of somatosensory evoked potentials (SSEP), free-run and stimulated electromyography (EMG), and motor evoked potentials (MEP). These have largely replaced the wake-up and clonus tests. Occasionally, other techniques are used (such as the Hoffman reflex). IOM requires a close cooperation between the surgical, monitoring, and anesthetic teams with a careful choice of anesthesia and physiological management.

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Abbreviations

APB:

Abductor pollicis brevis

AH:

Abductor hallucis

CMAP:

Compound muscle action potential

CN:

Cranial nerve

CST:

Corticospinal tract

DEP:

Dermatomal evoked potential

ECG:

Electrocardiogram

EMG:

Electromyography

Hz:

Hertz

H reflex:

Hoffman reflex

IOM:

Intraoperative neurological monitoring

MAC:

Minimal alveolar concentration

MEP:

Motor evoked potentials

mA:

milliamperes

MUP:

Motor unit potentials

NMEP:

Neurogenic motor evoked potentials

NMJ:

Neuromuscular junction

RLN:

Recurrent laryngeal nerve

SRS:

Scoliosis Research Society

SSEP:

Somatosensory evoked potentials

TA:

Tibialis anterior

TIVA:

Total intravenous anesthetic

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Authors and Affiliations

  1. Department of Anesthesiology, University of Colorado School of Medicine, MS B113 Leprino Office Building (LOB), 12401 E 17th Avenue, Aurora, CO, 80045, USA

    Tod B. Sloan M.D., MBA, Ph.D., Leslie Jameson M.D., Daniel Janik M.D. & Paul Mongan M.D.

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  1. Tod B. Sloan M.D., MBA, Ph.D.
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  2. Leslie Jameson M.D.
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  3. Daniel Janik M.D.
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  4. Paul Mongan M.D.
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Correspondence to Tod B. Sloan M.D., MBA, Ph.D. .

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Editors and Affiliations

  1. University of Colorado, Denver Dept. Orthopaedics, Aurora, Colorado, USA

    Vikas V. Patel

  2. Department of Orthopaedic Surgery Neurosciences Center, University of Utah, Salt Lake City, Utah, USA

    Alpesh Patel

  3. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA

    James S. Harrop

  4. University of Colorado, Denver Dept. Orthopaedics, Aurora, Colorado, USA

    Evalina Burger

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Sloan, T.B., Jameson, L., Janik, D., Mongan, P. (2014). Neurological Monitoring in Orthopedic Spine Surgery. In: Patel, V., Patel, A., Harrop, J., Burger, E. (eds) Spine Surgery Basics. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34126-7_11

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