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Impact of Intraoperative Neuromonitoring Alert Resolution on Motor Deficits and Short-Term Outcomes After Spine Fusion.

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Τίτλος: Impact of Intraoperative Neuromonitoring Alert Resolution on Motor Deficits and Short-Term Outcomes After Spine Fusion.
Συγγραφείς: Olson J; From the Department of Orthopedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA ., Dalton JF, Martinazzi B, Giakas A, Lee Y, Mathew J, Narayanan R, Tarawneh O, Oris RJ, Herczeg C, Baidya J, Huang R, Ng M, Baek G, Green WA, Eichbaum Y, Hitchner M, Witt L, Hammelef E, Middleton CJ, Patel K, Uvarov E, McCurdy M, Kaye ID, Cha TD, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK
Πηγή: The Journal of the American Academy of Orthopaedic Surgeons [J Am Acad Orthop Surg] 2026 Sep 15; Vol. 34 (18), pp. e2504-e2512. Date of Electronic Publication: 2025 Dec 30.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 9417468 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1940-5480 (Electronic) Linking ISSN: 1067151X NLM ISO Abbreviation: J Am Acad Orthop Surg Subsets: MEDLINE
Imprint Name(s): Publication: 2016- : Philadelphia : Wolters Kluwer
Original Publication: Rosemont, IL : American Academy of Orthopaedic Surgeons, c1993-
Ιατρικοί όροι (MeSH): Spinal Fusion*/adverse effects , Intraoperative Neurophysiological Monitoring*/methods , Postoperative Complications*/prevention & control , Postoperative Complications*/etiology, Humans ; Female ; Male ; Middle Aged ; Aged ; Retrospective Studies ; Adult ; Treatment Outcome
Περίληψη: Introduction: Intraoperative neurophysiologic monitoring (IONM) is commonly used during spinal surgery to track nerve function, with alerts indicating reduced nerve output and input. While IONM allows for surgical adjustments to mitigate nerve damage, its precise indications, effectiveness, and interpretation of alerts remain debated. Therefore, this study investigated the effect of IONM alert resolution on postoperative outcomes.
Methods: All adult patients who underwent spinal fusion with IONM and experienced an alert in 2017 at a single tertiary center were included. Patients who experienced mortality or had incomplete physical examination documentation were excluded. Postoperative weakness/deficit was defined as a decrease of ≥1 point on a five-point motor strength scale at either immediate postoperative or 2-week follow-up compared with preoperative strength. Deficits were categorized as immediate only, persistent, or de novo (appearing at 2 weeks). IONM alert resolution was graded as full (return to baseline), partial (improvement but no return to baseline), or no resolution. Statistical analysis used Kruskal-Wallis tests (alpha = 0.05).
Results: Our study included 115 patients, categorized by alert resolution: no resolution (n = 20), partial resolution (n = 22), and full resolution (n = 73). The partial and full resolution groups had higher cervical region involvement (86.4% and 67.1% vs. 25.0%, P < 0.001) compared with the no-resolution group. Otherwise, demographic characteristics were similar across groups. Notably, the degree of alert resolution was not associated with the rate, timing, or eventual resolution of postoperative motor deficits. Complications, length of stay, discharge disposition, and 90-day emergency department visits and readmissions were similar across groups.
Conclusion: Despite its frequent use in spine surgery, our findings suggest that the resolution of an IONM alert may not reliably predict the presence, timing, or reversibility of postoperative motor deficits. This suggests that neurologic injury, once indicated, may be more persistent than intraoperative monitoring alone can convey.
(Copyright © 2025 by the American Academy of Orthopaedic Surgeons.)
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Entry Date(s): Date Created: 20260626 Date Completed: 20260904 Latest Revision: 20260904
Update Code: 20260905
DOI: 10.5435/JAAOS-D-25-00907
PMID: 42357864
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1940-5480
DOI:10.5435/JAAOS-D-25-00907