Evaluating the Effectiveness of Intraoperative Neuromonitoring Modalities in Spinal Dysraphism Surgeries: A Systematic Review
DOI:
https://doi.org/10.5281/zenodo.14786910Keywords:
Spinal dysraphism, meningocele, myelomeningocele, tethered spinal cord, scoliosis, , bulbocavernosus reflex, multimodality, IONM, SSEP, MEP, EMG, BCR, pudendal, surgeryAbstract
Introduction: Spinal dysraphism encompasses a group of neural tube defects that can lead to significant neurological impairment, necessitating surgical intervention. Intraoperative neurophysiological monitoring (IONM) is integral to preserving neurological function during these high-risk surgeries. This systematic review evaluates the effectiveness of various IONM modalities, including somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), electromyography (EMG), and bulbocavernosus reflex (BCR), in reducing postoperative deficits.
Methods: A systematic review of the PubMed database from 1998 to 2024 was conducted per PRISMA guidelines. The keywords used in the research included “spinal dysraphism,” “IONM,” “neuromonitoring,” “spina bifida,” “pediatric,” “surgery,” and “neurosurgery.” Inclusion criteria specified that only English-language studies with at least 10 patients focused on IONM use in meningocele, myelomeningocele, and tethered spinal cord surgeries. Exclusion criteria ruled out reviews, case reports, conference abstracts, and animal studies. Neuromonitoring data were analyzed for efficacy in reducing postoperative neurological deficits compared to non-IONM surgeries.
Results: From 1,492 surgeries analyzed, 1,227 employed IONM, yielding a 7.25% postoperative neurological deficit rate compared to 15% in non-IONM procedures. Among the IONM group, multimodality monitoring consistently showed reduced risks of neurological complications. Variability in true positive and false negative rates among studies highlighted the need for standardized reporting and enhanced sensitivity across modalities.
Discussion: Multimodality IONM substantially reduces postoperative deficits, though its sensitivity and specificity require further refinement. Emerging techniques targeting sacral and autonomic pathways, such as pudendal nerve SSEPs and urinary bladder EMG and MEPs, offer promising advancements for comprehensive neural monitoring.
Conclusion: IONM significantly enhances surgical outcomes in spinal dysraphism by reducing postoperative neurological deficits. Standardized metrics, multimodal approaches, and innovation in monitoring techniques are essential to optimizing patient care. Future research should prioritize large-scale, controlled trials to validate these findings and enhance best practices.
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