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Incidence of postoperative neurological deficit with the use of an intraoperative neuromonitoring protocol for lateral lumbar interbody fusion – Lumbar Fusion

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This study discusses the use of intraoperative neuromonitoring (IONM) in lateral approaches to lumbar interbody fusion surgeries. The study aims to provide a standardized protocol for IONM and describe the clinical outcomes in a group of patients who underwent this surgery. A total of 169 patients were included in the study, and the results showed that most patients underwent surgery for degenerative spine conditions. Some patients triggered neuromonitoring alerts, and others demonstrated postoperative deficits (PODs). However, patients with PODs were less likely to trigger an alert. The study suggests that multilevel fusion is associated with PODs, and further research is needed to validate these findings using a more rigorous study design

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : the highest rated day surgery unit on Harley Street UK

Published article

S: This study provides a protocol algorithm for IONM alert responses in patients undergoing LLIF surgery. PODs are most associated with multilevel fusion, and patients with alerts had a low rate of persistent deficit. Future research is needed to validate these findings using a more rigorous comparative study design.

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J Neurosurg Spine. 2023 Nov 17:1-7. doi: 10.3171/2023.9.SPINE23263. Online ahead of print.ABSTRACTOBJECTIVE: Intraoperative neuromonitoring (IONM) has become commonplace in assessing neurological integrity during lateral approaches to lumbar interbody fusion surgeries. Neuromonitoring is designed to aid surgeons in identifying the potential for intraoperative nerve injury and reducing associated postoperative complications. However, standardized protocols for neuromonitoring have,

J Neurosurg Spine. 2023 Nov 17:1-7. doi: 10.3171/2023.9.SPINE23263. Online ahead of print.

ABSTRACT

OBJECTIVE: Intraoperative neuromonitoring (IONM) has become commonplace in assessing neurological integrity during lateral approaches to lumbar interbody fusion surgeries. Neuromonitoring is designed to aid surgeons in identifying the potential for intraoperative nerve injury and reducing associated postoperative complications. However, standardized protocols for neuromonitoring have not been provided, and outcomes are not well described. The purpose of this study was to provide a standardized protocol for IONM, and to describe clinical outcomes in a cohort of individuals who underwent lateral lumbar interbody fusion (LLIF) surgery.

METHODS: A retrospective review of 169 consecutive patients who underwent LLIF surgery at a single institution from October 2014 to October 2016 was performed. Patient characteristics, intraoperative details, clinical outcomes, and postoperative deficits (PODs) were compared between patients who did and did not trigger IONM alerts, and between patients who did and did not demonstrate a POD. A protocol for IONM decision-making was generated based on these observations.

RESULTS: Most patients (91.7%) underwent surgery for a degenerative spine condition. Twenty-three patients (13.6%) triggered neuromonitoring alerts, and 16 patients (9.5%) demonstrated a POD. Leg pain, back pain, and disability improved significantly (p < 0.045), and 2 patients had both motor and sensory deficits at the 12-week postoperative time point. Patients with a POD demonstrated greater operating room time (p = 0.034) and a greater number of interbody fusion levels (p = 0.015) but were less likely to have triggered a neuromonitoring alert (p = 0.04). There was no association between retractor time and POD (p = 0.98). When an IONM protocol was followed, individuals who experienced a POD were less likely to trigger an alert than those who did not experience a POD (p = 0.04).

S: This study provides a protocol algorithm for IONM alert responses in patients undergoing LLIF surgery. PODs are most associated with multilevel fusion, and patients with alerts had a low rate of persistent deficit. Future research is needed to validate these findings using a more rigorous comparative study design.

PMID:37976512 | DOI:10.3171/2023.9.SPINE23263

The London Spine Unit : the highest rated day surgery unit on Harley Street UK

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Incidence of postoperative neurological deficit with the use of an intraoperative neuromonitoring protocol for lateral lumbar interbody fusion

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J Neurosurg Spine. 2023 Nov 17:1-7. doi: 10.3171/2023.9.SPINE23263. Online ahead of print.ABSTRACTOBJECTIVE: Intraoperative neuromonitoring (IONM) has become commonplace in assessing neurological integrity during lateral approaches to lumbar interbody fusion surgeries. Neuromonitoring is designed to aid surgeons in identifying the potential for intraoperative nerve injury and reducing associated postoperative complications. However, standardized protocols for neuromonitoring have

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