Role of Intraoperative Neuro-Monitoring in Preventing Neurological Deficits During Spine Surgery: A Study of 70 Cases

Abstract

Neurological injury remains one of the most significant and devastating complications associated with spine surgery, often resulting in prolonged disability and reduced quality of life. Intraoperative neuro-monitoring (IONM) has been increasingly integrated into modern surgical practice to provide real-time assessment of spinal cord and nerve root integrity, thereby enabling timely intervention when neural compromise is detected. This study aimed to evaluate the role of IONM in preventing postoperative neurological deficits in a series of 70 patients undergoing various spine procedures. This prospective observational study was conducted between November-2023 to December-2024 and included adult patients undergoing cervical, thoracic, lumbar, or deformity-related spinal surgeries with multimodal IONM. Modalities utilized included somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), electromyography (EMG), and neuromuscular blockade monitoring. Data were collected on demographic characteristics, type of surgery, frequency and nature of IONM alerts, intraoperative corrective measures, and postoperative neurological outcomes. Among the 70 patients included, IONM alerts were recorded in 12 cases (17.1%). MEP changes accounted for the majority of alerts, followed by SSEP reductions and EMG root irritation signals. Surgeons implemented timely corrective actions—such as adjusting instrumentation, elevating mean arterial pressure, reversing correction maneuvers, or optimizing anesthesia—in response to these alerts. Following intervention, 83.3% of the alerts resolved intraoperatively, preventing the progression to neurological injury. Two patients (2.8%) experienced transient postoperative neurological deficits, both of whom had persistent abnormal IONM signals despite corrective measures. Importantly, no patients in this cohort developed permanent neurological deficits. The findings of this study underscore the effectiveness of multimodal IONM in enhancing patient safety during spine surgery. IONM provided early detection of neural compromise, allowing for timely intraoperative changes that significantly reduced the incidence of neurological injury. The low rate of postoperative deficits, along with the complete absence of permanent neurological impairment, highlights the critical role of IONM particularly MEPs and SSEPs in safeguarding neural structures during complex spinal procedures. Widespread adoption of IONM, especially in high-risk surgeries, is strongly recommended to improve surgical outcomes and reduce neurological morbidity.

Keywords: Intraoperative Neuro-Monitoring, Spine Surgery, Motor Evoked Potentials, Somatosensory Evoked Potentials, Neurological Deficits, Electromyography, Multimodal Monitoring.