Review of the Role of Intraoperative Neurophysiological Monitoring in Spinal Surgery With a Focus on the True and False Positives and a Clinical Correlation

Article Figures & Data

Table 1

McCormick Neurologic Scale used to characterize neurological status.

Grade	Description
I	Neurological status intact, ambulating normally, minimal dysesthesia
II	Mild sensory of motor deficit, functioning independently
III	Moderate deficit, some limitation of function, maintains independence with external aid
IV	Severe sensory or motor deficit, function very limited, dependent on others
V	Paraplegia or quadriplegia, even in presence of flickering movement

Table 2

Types of operations monitored (N = 169).

Operations	No. (%) of Cases
Anterior cervical discectomy and fusion	72 (42.6%)
Anterior cervical discectom and fusion (revision)	1 (0.6%)
Posterior cervical discectomy and fusion	25 (14.8%)
Posterior occipital cervical fusion	5 (3%)
Cervical corpectomy	3 (1.8%)
Cervical discectomy	4 (2.4%)
Thoracic corpectomy	3 (1.8%)
Thoracic fusion (revision)	4 (2.4%)
Thoracolumbar decompression and fusion	17 (10%)
Lumbar discectomy and fusion	1 (0.6%)
Lumbar fusion (revision)	4 (2.4%)
Posterior thoracolumbar instrumented fusion (scoliosis correction)	29 (17.2%)
Scoliosis correction (revision)	1 (0.6%)
Removal of intervertebral disc prosthesis	1 (0.6%)

Table 3

Indications for neuromonitoring.

Indications	No. (%) of Cases
Cervical stenosis	70 (41.4%)
Cervical stenosis w/ disc prolapse	2 (1.2%)
Cervical disc prolapse	24 (14.2%)
Cervical osteomyelitis	1 (0.6%
Central cord syndrome	1 (0.6%)
Degenerative joint disease	5 (3%)
Thoracic stenosis	1 (0.6%)
Thoracic no. (fracture)	3 (1.8%)
Thoracic discitis and osteomyelitis	1 (0.6%)
Thoracic lesion	1 (0.6%)
Thoracolumbar scoliosis	28 (16.6%)
Lumbar stenosis	3 (1.8%)
Lumbar no. (fracture)	3 (1.8%)
Lumbar disc prolapse	1 (0.6%)
Metastases
Lung	4 (2.4%)
Breast	3 (1.8%)
Renal	2 (1.18%)
Prostate	1 (0.6%)
Bowel	1 (0.6%)
Thyroid (papillary)	1 (0.6%)
Thymus	1 (0.6%)
Ankylosing spondylitis	1 (0.6%)
Rheumatoid arthritis (C1-C2 subluxation)	1 (0.6%)
Other	1 (0.6%)