Intraoperative neurophysiological monitoring of surgeries at the cervical spine

Intraoperative injury to the spinal cord is an infrequent but potentially catastrophic complication of cervical spine surgery. To reduce the incidence of major neurologic morbidity, neurophysiological and electromyographic recordings have been made intraoperatively. Although definitive prospective studies have not been conducted and probably will not be undertaken, findings from retrospective studies and case reports indicate that intraoperative monitoring (IOM) has helped surgeons to reduce the incidence of catastrophic neurologic complications. Many factors need to be considered when determining the usefulness of IOM, including estimated rate of neurologic injury for a particular procedure, the cervical level of the surgery, preexisting neurologic deficits of the patient, and the sensitivity of the monitoring procedure to the tissue that is at risk.