Femoral Nerve Monitoring During Lateral Spine Surgery
DOI:
https://doi.org/10.5281/zenodo.10215106Keywords:
SSEP, EMG, TOF, TCeMEP, PLIF, OLIF, TLIF, LLIF, SnSSEP, femoral nerve, saphenous nerveAbstract
Objective: To review evidence on the use of somatosensory evoked potentials (SSEP), transcranial electric motor evoked potentials (TCeMEP), electromyography (EMG), train of four (TOF), and multimodal intraoperative neurophysiological monitoring (mIONM) of the femoral and saphenous nerves in spinal procedures with a lateral approach.
Methods: A literature review was conducted to identify retrospective clinical studies with outcomes of patients who underwent lateral spine surgeries with intraoperative monitoring of the femoral and saphenous nerves. Postoperative neurologic sensory and motor deficits were analyzed. The efficacy and accuracy of SSEP, TCeMEP, EMG, TOF, and mIONM were investigated during lateral spine approach surgeries.
Results: TCeMEP monitoring is associated with a lower rate of postoperative neurologic deficits, both sensory and motor, compared to EMG monitoring only. Multimodal IONM strategies using TCeMEPs or saphenous SSEPs (SnSSEPs) may be promising. Distal saphenous nerve SSEPs (DSn-SSEPs) can optimize recordings during lateral lumbar procedures and improve outcomes.
Conclusion: When performing lateral spine surgeries, a multimodal approach that includes the use of EMG, TCeMEP, and SSEP may reduce the incidence of adverse postoperative findings and offer an opportunity to intervene in developing iatrogenic nerve injuries to femoral and/or saphenous nerves.
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