Intraoperative Neurophysiological Monitoring During Spinal Cord Stimulation Surgery: A Systematic Review

Janine-Ai Schlaeppi; Raphael Schreen; Kathleen Seidel; Claudio Pollo

doi:10.1016/j.neurom.2023.06.010

Intraoperative Neurophysiological Monitoring During Spinal Cord Stimulation Surgery: A Systematic Review

Neuromodulation. 2023 Oct;26(7):1319-1327. doi: 10.1016/j.neurom.2023.06.010.

Authors

Janine-Ai Schlaeppi¹, Raphael Schreen², Kathleen Seidel², Claudio Pollo²

Affiliations

¹ Department of Neurosurgery, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: Janine.Schlaeppi@insel.ch.
² Department of Neurosurgery, Bern University Hospital, University of Bern, Bern, Switzerland.

PMID: 37802585
DOI: 10.1016/j.neurom.2023.06.010

Abstract

Objectives: This study aims to describe the state of literature regarding the use of intraoperative neurophysiological monitoring (IONM) during spinal cord stimulator surgery.

Materials and methods: A systematic review of the use of IONM during spinal cord stimulation (SCS) surgery was performed using the following three data bases: PubMed, Ovid MEDLINE, and Embase. Research techniques included systematic research following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol by Cochrane, and backward searching. Qualitative analysis of included articles was performed using the methodologic index for nonrandomized studies assessment tool. Direction of effect, consistency across studies, and cost-effectiveness were narratively synthesized.

Results: A total of 15 records were identified through data base searching. All records used IONM methods under general anesthesia for guidance of epidural lead placement. IONM techniques used for determining lateralization in the found articles were compound muscle action potentials (CMAPs) (n = 8), somatosensory evoked potentials (SSEPs) (n = 3) or both (n = 4). Motor evoked potentials were used in three trials for neuroprotection purposes. Two studies were comparative, and 12 were noncomparative.

Conclusions: We found a good body of level II evidence that using IONM during SCS surgery is a valid alternative to awake surgery and may even be superior regarding pain management, cost-effectiveness, and postoperative neurologic deficits. In direct comparison, the found evidence suggested using CMAP provided more consistently favorable results than using SSEP for midline placement of epidural leads under general anesthesia. Selection of IONM modality should be made on the basis of pathophysiology of disease, individual IONM experience, and the individual patient.

Keywords: Evoked potentials; IONM; implantable neurostimulators; intraoperative neurophysiological monitoring; spinal cord stimulation.

Publication types

Systematic Review
Review

MeSH terms

Brain Neoplasms*
Evoked Potentials, Motor / physiology
Humans
Intraoperative Neurophysiological Monitoring* / methods
Neurosurgical Procedures / methods
Retrospective Studies
Spinal Cord Stimulation*
Wakefulness