Our Summary

This research paper is a review and analysis of other studies to see if using intraoperative neurophysiological monitoring (IONM) during spinal surgery can help prevent damage to the nervous system. IONM is a method used to keep track of the nervous system’s function during surgery.

The researchers looked at different studies where patients had spinal surgery with and without IONM and then compared the rate of new neurological issues that came up after surgery. They found a wide range of results across the studies. There was no significant evidence to show that using IONM led to fewer neurological problems overall. However, they did observe a trend suggesting that when IONM was used during surgeries for a specific kind of spinal issue (intramedullary lesions), there were fewer neurological problems post-surgery.

In conclusion, the researchers suggest that more detailed, randomized studies are needed to better understand when it’s best to use IONM in spinal surgeries.

FAQs

  1. What is intraoperative neurophysiological monitoring (IONM) and how is it used in spinal surgery?
  2. Did the research find any significant evidence that using IONM prevents neurological problems following spinal surgery?
  3. What specific kind of spinal issue did the researchers find may benefit from the use of IONM during surgery?

Doctor’s Tip

When considering spinal surgery, it is important to discuss the use of intraoperative neurophysiological monitoring (IONM) with your surgeon. While there is some evidence to suggest that IONM may help prevent nerve damage during certain types of spinal surgeries, more research is needed to determine its overall effectiveness. Make sure to have a thorough discussion with your doctor about the potential benefits and risks of using IONM in your specific case.

Suitable For

In general, patients who may be recommended for spinal surgery include those with severe and persistent back or neck pain, spinal deformities, spinal fractures, spinal tumors, spinal stenosis, herniated discs, and spinal instability. These patients may have tried conservative treatments such as physical therapy, medications, and injections without success, and surgery may be considered as a last resort to alleviate their symptoms and improve their quality of life.

It is important for a thorough evaluation by a spine specialist to determine if a patient is a good candidate for surgery, as not all patients with spinal issues may benefit from surgical intervention. Factors such as the severity of symptoms, the underlying cause of the spinal issue, the patient’s overall health, and their willingness to undergo such a procedure will all be taken into consideration when deciding if surgery is the best course of action.

Ultimately, the decision to recommend spinal surgery will be based on the individual patient’s specific circumstances, and a multidisciplinary team of healthcare providers will work together to provide the best possible treatment plan for each patient.

Timeline

Timeline before spinal surgery:

  • Patient experiences back pain or other symptoms that lead them to seek medical attention
  • Consultation with a spine specialist to discuss treatment options, including the possibility of surgery
  • Pre-operative testing and imaging to assess the extent of the spinal issue
  • Patient educates themselves on the procedure, risks, and recovery process
  • Surgical consent is obtained
  • Patient undergoes pre-operative preparation, including fasting and stopping certain medications
  • Patient is admitted to the hospital on the day of surgery

Timeline after spinal surgery:

  • Patient is taken to the operating room and undergoes spinal surgery with or without IONM
  • Patient wakes up in the recovery room and is monitored closely for any immediate post-operative complications
  • Patient is transferred to a hospital room or discharged home, depending on the type of surgery
  • Patient begins the post-operative recovery process, which may include physical therapy, pain management, and follow-up appointments with the surgeon
  • Patient gradually resumes normal activities and monitors for any new or worsening neurological symptoms
  • Patient follows up with the surgeon for long-term monitoring of the surgical outcome and any potential complications

What to Ask Your Doctor

Some questions a patient should ask their doctor about spinal surgery and the use of intraoperative neurophysiological monitoring (IONM) include:

  1. What is the purpose of using IONM during my spinal surgery?
  2. Will I benefit from having IONM during my specific type of spinal surgery?
  3. Are there any risks or complications associated with using IONM during surgery?
  4. How will IONM help prevent damage to my nervous system during surgery?
  5. What are the potential outcomes if I choose to have IONM versus not having it during my surgery?
  6. How experienced is the surgical team in using IONM technology?
  7. What alternative methods are available if I choose not to have IONM during my surgery?
  8. Can you provide me with any research or studies that support the use of IONM in spinal surgeries?
  9. How will I be monitored and cared for during the surgery if I choose to have IONM?
  10. What is the likelihood of experiencing new neurological issues post-surgery if I choose to have IONM versus not having it?

Reference

Authors: Daniel JW, Botelho RV, Milano JB, Dantas FR, Onishi FJ, Neto ER, Bertolini EF, Borgheresi MAD, Joaquim AF. Journal: Spine (Phila Pa 1976). 2018 Aug;43(16):1154-1160. doi: 10.1097/BRS.0000000000002575. PMID: 30063222