Intraoperative multimodal monitoring in pedicle subtraction osteotomies of the lumbar spine: A narrative literature review
Document Type
Article
Abstract
© 2018 Wolters Kluwer Health, Inc. All rights reserved. The use of intraoperative multimodal monitoring (IOM) in spinal deformity surgeries is well documented. In particular, pedicle subtraction osteotomy (PSO), a corrective procedure for sagittal deformity of the spine, often involves IOM usage. By providing immediate feedback to the operating surgeon, IOM has the potential to eliminate or at least minimize the risk of iatrogenic neurological injury. However, despite the widespread usage of IOM, there is currently no standardization of IOM usage in complex spine surgeries, including lumbar PSOs, and decisions concerning IOM utilization are often driven by surgeon experience and preference. This creates a state of clinical equipoise, which is further complicated by the varying degrees of benefit that IOM has on patient outcomes depending on the operation and spinal levels involved. For instance, while IOM use in thoracic PSOs has been shown to be effective, there is no established consensus on the net impact of IOM use in PSOs of the lumbar spine. Although IOM has the potential to mitigate neurological damage, it also increases operation time and cost; thus, it should only be used in operations where it will have a net positive impact on patient outcomes. The question thus becomes whether PSO of the lumbar spine is one such operation. To address this, we examine the most frequently used IOM modalities and evaluate their current usage and efficacy in lumbar PSOs. Furthermore, we will also examine the utility of IOM for other surgeries of the lumbar spine, including corrective procedures for idiopathic scoliosis and degenerative scoliosis, and routine lumbar procedures, such as discectomies and decompression surgeries for foraminal and canal stenosis.
Publication Date
5-1-2019
Publication Title
Clinical Spine Surgery
ISSN
23800186
E-ISSN
23800194
Volume
32
Issue
4
First Page
137
Last Page
142
PubMed ID
30407261
Digital Object Identifier (DOI)
10.1097/BSD.0000000000000740
Recommended Citation
Shao, Jianning; Lee, Bryan S.; Pelle, Dominic; Lee, Maxwell Y.; Savage, Jason; Tanenbaum, Joseph E.; Mroz, Thomas E.; and Steinmetz, Michael P., "Intraoperative multimodal monitoring in pedicle subtraction osteotomies of the lumbar spine: A narrative literature review" (2019). Neurosurgery. 806.
https://scholar.barrowneuro.org/neurosurgery/806