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Intraoperative Neurophysiological Monitoring in Spine Surgery

A Systematic Review and Meta-Analysis

Daniel, Jefferson Walter, MD, PhD; Botelho, Ricardo Vieira, MD, PhD; Milano, Jerônimo Buzetti, MD, PhD; Dantas, Fernando Rolemberg, MD, MSc§; Onishi, Franz Jooji, MD; Neto, Eloy Rusafa, MD||; Bertolini, Eduardo de Freitas, MD; Borgheresi, Marcelo Antonio Duva, MD∗∗; Joaquim, Andrei Fernandes, MD, PhD††,‡‡

doi: 10.1097/BRS.0000000000002575

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

Neurosurgeon, Santa Casa de São Paulo – School of Medical Sciences, São Paulo, Brazil

Neurosurgeon, Hospital do Servidor Público Estadual, São Paulo-SP, Brazil

Neurosurgeon, Neurological Institute of Curitiba, Curitiba-PR, Brazil

§Neurosurgeon, Hospital Biocor, Belo Horizonte, Minas Gerais, Brazil

Neurosurgeon – Federal University of São Paulo (UNIFESP), São Paulo-SP, Brazil

||Neurosurgeon – University of São Paulo (USP), São Paulo-SP, Brazil

∗∗Neurosurgeon, Santa Casa de Santos, Santos, SP, Brazil

††Neurosurgeon – State University of Campinas (UNICAMP), Campinas-SP, Brazil

‡‡A document from the Spine Department – Brazilian Society of Neurosurgery.

Address correspondence and reprint requests to Ricardo Vieira Botelho, MD, PhD, Department of Neurosurgery – Hospital do Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil; E-mail:

Received 16 October, 2017

Revised 9 November, 2017

Accepted 7 December, 2017

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.