A practical guide to carrying out neurophysiological monitoring in spine surgery

Introduction and aims. The main purposes of intraoperative monitoring during spine surgery are to avoid damage to nerve structures, to guide the surgeon in the extension of the correction, to identify structures and to ensure the patient receives the best possible attention. Several multicentre studies have shown that performing neurophysiological monitoring of spinal cord functioning during spine surgery reduces the incidence of post-surgical neurophysiological injury by up to 50%. A number of different neurophysiological tests have been developed to monitor spinal cord functioning during surgery but no agreement has been reached about which is the best method. In this work, the Spanish Society of Clinical Neurophysiology, through a panel of experts, has surveyed the main monitoring techniques used during spine surgery and has drawn up a series of best practice guidelines. Development. None of the techniques described to date is totally free of drawbacks. Nevertheless, what authors do agree about, both in the Spanish and international literature, is the advisability of having several types of potential available so that they can be used if and when the neurophysiologist sees fit, while also allowing the disadvantages of each different type to be compensated, which in turn means an increased degree of safety for the patient. Conclusions. Monitoring requires a multidisciplinary team and the neurophysiologist must be fully competent in this area. With this guide, the Spanish Society of Clinical Neurophysiology conducts a review of the different techniques available and lays down the criteria for interpreting the results and the risk criteria of the most important techniques.