Application of intraoperative neurophysiological monitoring in unilateral biportal endoscopic lumbar spine surgery.

OBJECTIVE

To analyze the value of intraoperative neurophysiological monitoring (IONM) in unilateral biportal endoscopic (UBE) lumbar spine surgery.

METHODS

A retrospective analysis was performed on 127 patients who underwent UBE lumbar spine surgery at Xicheng Branch of Beijing Friendship Hospital from January 2024 to September 2024. Patients were divided into two groups: the observation group (IONM, 64 cases) and the control group (no IONM, 63 cases). Changes of monitoring indicators included somatosensory evoked potentials (SEP), motor evoked potentials (MEP), and free electromyography (freeEMG) were recorded. Age, sex, body mass index, surgery length, surgical levels, surgery time, intraoperative fluid volume, post anesthesia care unit time, time to first ambulation, length of hospital stay, leg visual analog scale (VAS), preoperative and postoperative fall scores, activities of daily living, and postoperative complication of two groups were collected and compared.

RESULTS

In the observation group, 40 cases (62.5%) showed freeEMG stimulation. 10 cases (15.6%) had a significant decrease in MEP amplitudes, with 9 cases showing a decline in MEP amplitudes immediately following freeEMG stimulation. No significant changes in SEP. The postoperative 24-hour leg VAS in the observation group was 1.8 ± 0.4, which was significantly lower than the 2.1 ± 0.2 in the control group (p < 0.001). No significant differences were found between the two groups in terms of surgical time and other data (p > 0.05).

CONCLUSION

IONM provides timely information of neurological function in UBE lumbar spine surgery, reduces the invasiveness of intraoperative procedures, and reduce early postoperative leg pain.