The Essence of Neuromonitoring: 23 Year Retrospective Study of 3436 Spinal Deformity Surgeries, Staggering 99.6% Accuracy/Detection of Permanent damage!

 Emerson RG's article published in the latest issue of Journal of Clinical Neurophysiology must be an eye opener for Naysayer neurologists and to those skeptic spine specialists out there who is impetuously discredit the predictability values and reliability of intraoperative neurophysiological monitoring. My own personal IONM experience provided to more than 1500 surgical procedures reveal even more than 99.6% accuracy of detection, wherein about 4-5 spine patients lives been saved (four lumbar and cervical fusion spine cases, and one scoliosis procedure) because of the timely warning from the IONM results during the surgical procedures, the timely warning enabled surgeon to take immediate intervention measures to reverse the risk of permanent damage thereby saved the patient from paralysis.

               The number of years accounted in this study, and the number of patients who underwent surgical procedures used for this analysis of Dr.Emerson's study is compelling and producing an authoritative findings. It is a must have clinical paper for all those who work in IONM field and a great reference source to be given to those naysayers.

J Clin Neurophysiol. 2012 Apr;29(2):149-50.

NIOM for spinal deformity surgery: there's more than one way to skin a cat.

Emerson RG. Abstract

STUDY DESIGN: This was a 23-year retrospective study of 3436 consecutive pediatric orthopedic spinal surgery patients between 1995 and 2008.

OBJECTIVE: To demonstrate the effectiveness of multimodality electrophysiologic monitoring in reducing the incidence of iatrogenic neurologic deficit in a pediatric spinal surgery population.

SUMMARY OF BACKGROUND DATA: The elective nature of many pediatric spinal surgery procedures continues to drive the need for minimizing risk to each individual patient. Electrophysiologic monitoring has been proposed as an effective means of decreasing permanent neurologic injury in this population.

METHODS: A total of 3436 consecutive monitored pediatric spinal procedures at a single institution between January 1985 and September 2008 were reviewed. Monitoring included somatosensory evoked potentials, descending neurogenic evoked potentials, transcranial electric motor evoked potentials, and various nerve root monitoring techniques. Patients were divided into 10 diagnostic categories. True-positive and false-negative monitoring outcomes were analyzed for each category. Neurologic deficits were classified as transient or permanent.

RESULTS: Seven of 10 diagnostic groups demonstrated true-positive findings resulting in surgical intervention. Seventy-four (2.2%) potential neurologic deficits were identified in 3436 pediatric surgical cases. Seven patients (0.2%) had false-negative monitoring outcomes. These patients awoke with neurologic deficits undetected by neuromonitoring. Intervention reduced permanent neurologic deficits to 6 (0.17%) patients. Monitoring data were able to detect permanent neurologic status in 99.6% of this population. The ratio of intraoperative events to total monitored cases was 1 event every 42 surgical cases and 1 permanent neurologic deficit every 573 cases.

CONCLUSIONS: The combined use of somatosensory evoked potentials, transcranial electric motor evoked potentials, descending neurogenic evoked potentials, and electromyography monitoring allowed accurate detection of permanent neurologic status in 99.6% of 3436 patients and reduced the total number of permanent neurologic injuries to 6.