Intraoperative neuromonitoring in single-level minimally invasive surgery transforaminal lumbar interbody and fusion
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Abstract
Minimally invasive surgery (MIS) with application of high level safety intraoperative neuromonitoring in spine is currently a growing trend and expanding its indications, especially in the management of severe lumbo-sacral spondylolisthesis. 50 patients with single-level lumbo-sacral spondylolisthesisunderwent MIS TLIF surgery using intraoperative neuromonitoring from November 2022 to December 2024. Patients were anesthetized without muscle relaxation, baseline was taken and follow by protocol based on EMG, MEP and TrEMG. The corresponding sensitivities and specificities between the IONM modalities: EMG, MEP and EMG/MEP were: 33.3% and 95.7%, 66.7% and 95.7% and 66.7% and 97.8%, respectively. The TrEMG was used in 10 patients, all signal was in the safe zone. 2 cases with signal change appear with radicular pain post operative which improved to conservative treatment. The clinical improvement in the negative group was similar and there was a difference between the positive and false positive groups. The clinical symptom post operative 6 months is related to the improvement of IONM modal; from 6 to 12 months. No complications or nerve function were recorded post operative. Using multimodal neuromonitoring during surgery ensures safety with high sensitivity and specificity. The degree of improvement in wave amplitude post operative is equivalent to the progression of symptoms after 6 months.
Article Details
Keywords
Intraoperative neurological monitoring, EMG, MEP, TrEMG
References
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