Arakal Rajesh G, Courtois Emily C, Ohnmeiss Donna D
Orthopedic Surgery, Texas Back Institute, Plano, USA.
Research, Texas Back Institute, Plano, USA.
Cureus. 2025 Aug 11;17(8):e89832. doi: 10.7759/cureus.89832. eCollection 2025 Aug.
Intraoperative neuromonitoring (IONM) was integrated into most types of spine surgery to help prevent intraoperative nerve injury. Concern has been raised for the actual benefit provided by IONM, particularly in the current era of navigation and robotic guided surgery. The purpose of this study was to investigate IONM changes and postoperative neurologic deficits during lateral lumbar interbody fusion (LLIF).
This was a cross-sectional study on a consecutive series of 202 patients who underwent LLIF procedures from January 2022 to September 2022. Patients were included if 18 years of age or older and underwent fusion at one, two, or three levels. Data were collected from patient chart review and operative reports, including intraoperative changes in neuromonitoring. Postoperative clinic notes were reviewed for up to approximately three months postoperatively for indication of neurologic injury. IONM was conducted using somatosensory evoked potential (SSEP).
There were two false negatives in this cohort (1.00%), involving no IONM change but exhibiting a neurologic deficit postoperatively. There was one true positive (0.50%) involving a reported IONM change and postoperative neurologic deficit; however, the IONM change occurred just after the patient was flipped prone for the posterior instrumentation portion of the LLIF procedure. The surgeon confirmed through new imaging that the fusion cage was in the appropriate position.
This study found that changes in IONM were rare (0.50%). In the case of the one true positive, this occurred during repositioning, and the IONM change was not successful as a preventative measure. These results indicate that the use of SSEPs may not be supported for the LLIF approach. While medico-legal concerns promote its usage, the low rates of neurologic deficits and costs associated with IONM should be considered, leading to a reexamination of its use in LLIF spinal surgery.
术中神经监测（IONM）已被纳入大多数类型的脊柱手术中，以帮助预防术中神经损伤。人们对IONM所提供的实际益处提出了担忧，尤其是在当前导航和机器人辅助手术的时代。本研究的目的是调查腰椎侧方椎间融合术（LLIF）期间IONM的变化以及术后神经功能缺损情况。
这是一项横断面研究，对2022年1月至2022年9月连续接受LLIF手术的202例患者进行了研究。纳入年龄在18岁及以上、接受单节段、双节段或三节段融合的患者。通过查阅患者病历和手术报告收集数据，包括神经监测的术中变化。术后门诊记录在术后约三个月内进行复查，以确定是否存在神经损伤迹象。IONM采用体感诱发电位（SSEP）进行。
该队列中有2例假阴性（1.00%），术中IONM无变化，但术后出现神经功能缺损。有1例假阳性（0.50%），术中IONM有变化且术后出现神经功能缺损；然而，IONM变化发生在患者在LLIF手术的后路器械置入部分翻身俯卧后不久。外科医生通过新的影像学检查确认融合器位置合适。
本研究发现IONM变化罕见（0.50%）。在1例假阳性病例中，这种情况发生在重新定位期间，且IONM变化作为预防措施并不成功。这些结果表明，LLIF手术方式可能不支持使用SSEP。虽然医疗法律方面的担忧促使其使用，但应考虑神经功能缺损的低发生率以及与IONM相关的成本，从而重新审视其在LLIF脊柱手术中的应用。
