Intraoperative neurophysiological monitoring for anterior cervical discectomy and fusion

Intraoperative neurophysiological monitoring for anterior cervical discectomy and fusion

Although Intraoperative neurophysiological monitoring has been shown to decrease the risk of neurological injury in deformity surgery, its utility in anterior cervical spine surgery (ACSS) remains controversial 1) 2) 3) 4) 5) 6)7) 8).

Proponents of intraoperative neurophysiological monitoring for ACSS claim that it improves patient safety and functional outcome whereas opponents refute this claim by citing increased cost and the lack of correlation between intraoperative neurophysiological monitoring abnormalities and postoperative neurological deficits especially with anterior cervical discectomy and fusions (ACDFs) 9) 10) 11) 12).

In a systematic review and meta-analysis from 2017, the risk of neurological injury after ACSS was low although procedures involving a corpectomy may carry a higher risk. For ACDFs, there is no difference in the risk of neurological injury with or without ION use. Unimodal ION has a higher specificity than multimodal ION and may minimize “subclinical” intraoperative alerts in ACSS 13)

A analysis of over 140,000 cases from the National Inpatient Sample data set, found that the use of intraoperative neurophysiological monitoringfor anterior cervical discectomy and fusion was not associated with a reduced rate of neurological complication14).



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Ajiboye RM, Zoller SD, Sharma A, Mosich GM, Drysch A, Li J, Reza T, Pourtaheri S. Intraoperative Neuromonitoring for Anterior Cervical Spine Surgery: What Is the Evidence? Spine (Phila Pa 1976). 2017 Mar 15;42(6):385-393. doi: 10.1097/BRS.0000000000001767. Review. PubMed PMID: 27390917; PubMed Central PMCID: PMC5552368.

Badhiwala JH, Nassiri F, Witiw CD, Mansouri A, Almenawer SA, da Costa L, Fehlings MG, Wilson JR. Investigating the utility of intraoperative neurophysiological monitoring for anterior cervical discectomy and fusion: analysis of over 140,000 cases from the National (Nationwide) Inpatient Sample data set. J Neurosurg Spine. 2019 Mar 29:1-11. doi: 10.3171/2019.1.SPINE181110. [Epub ahead of print] PubMed PMID: 30925481.

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