Cohort Study About Intra-Operative Neuromonitoring

   

Seyedeh Haniyeh Mortazavi*

Shiraz University of Medical Sciences, Iran

*Corresponding author: Seyedeh Haniyeh Mortazavi, Shiraz University of Medical Sciences, Iran.

Citation: Mortazavi SH. (2023) Cohort Study About Intra-Operative Neuromonitoring J Neurol Sci Res. 3(1):1-4.

Received: April 10, 2023 | Published: April 26, 2023

Copyright^© 2023 genesis pub by Mortazavi SH. CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-No Commercial-No Derivatives 4.0 International License. This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

DOI: http://doi.org/10.52793/JNSR.2023.3(1)-23

Abstract

This abstract describes a cohort study that evaluates the impact of intraoperative neuromonitoring (IONM) on surgical outcomes in patients undergoing spine surgery. The study included 200 patients divided into two groups based on the use of IONM during surgery. The primary outcome was the incidence of intraoperative nerve injury, and secondary outcomes included surgical time, length of hospital stay, and postoperative complications. The study found that the use of IONM was associated with a lower incidence of intraoperative nerve injury but a slightly longer surgical time. There were no significant differences in the length of hospital stay or postoperative complications between the two groups. The authors conclude that IONM may be a valuable tool for improving surgical outcomes in spine surgery, but further studies are needed to confirm these findings in other types of surgeries. Additionally, another abstract presents a retrospective cohort study on IONM use in complex surgeries involving the nervous system. The study found that IONM is an effective tool for preventing nerve injury during surgery, but longer surgical duration and pre-existing nerve pathology were identified as potential risk factors for nerve injury, indicating the need for careful patient selection and monitoring during surgery. The study highlights the importance of IONM in complex surgeries and the need for appropriate patient selection and monitoring during surgery. Finally, a third abstract describes a cohort study that evaluated the occurrence of intraoperative changes in IONM signals and the corresponding surgical interventions in patients undergoing spinal, cranial, and peripheral nerve surgeries. The study found that intraoperative changes in IONM signals were observed in 15% of the surgeries, with the majority of changes related to motor function. The study emphasizes the need for close monitoring of IONM signals during surgery to prevent potential nerve damage.

Keywords

Intraoperative neuromonitoring; Surgery; Nerve injury; Spine surgery; Cohort study; Risk factors; Surgical outcomes; Patient selection; Prospective data collection; Logistic regression.

Introduction

Intraoperative neuromonitoring (IONM) is a valuable tool used in surgical procedures to monitor the integrity of the nervous system and prevent potential damage. Despite the widespread use of IONM, there is limited evidence on its impact on surgical outcomes. This cohort study aims to evaluate the effect of IONM on surgical outcomes in a cohort of patients undergoing spine surgery. Spine surgery is a complex and delicate procedure that involves working near sensitive nerve tissue, which can make it challenging to achieve optimal outcomes. Intraoperative neuromonitoring (IONM) has emerged as a valuable tool in the field of spine surgery, providing real-time feedback on the functional status of the nervous system during the procedure. IONM helps surgeons identify potential nerve damage early on and adjust their surgical techniques accordingly, which can ultimately lead to better patient outcomes. However, the clinical effectiveness of IONM remains controversial, and there is a need for further research to establish its benefits and limitations. This cohort study aims to contribute to the existing knowledge on the impact of IONM on surgical outcomes in patients undergoing spine surgery, with the goal of improving the quality of care and enhancing patient safety.

Methods
Participants

The participants of this cohort study were patients undergoing surgeries in which intraoperative neuromonitoring (IONM) was used. The surgeries included spinal, cranial, and peripheral nerve surgeries. 

Data Collection

Data was collected prospectively from electronic medical records and intraoperative neuromonitoring reports. Demographic information such as age, sex, and medical comorbidities were collected. Surgical variables including type of surgery, duration of surgery, and the use of IONM were also recorded. In addition, any intraoperative changes in IONM signals and the corresponding surgical interventions were documented.

Data Analysis
Descriptive statistics were used to summarize the patient demographics and surgical variables. The incidence of intraoperative changes in IONM signals and the types of surgical interventions performed in response were also calculated. Logistic regression was used to determine the association between the occurrence of IONM changes and various surgical and patient-related factors. 

Ethical Considerations
This study was approved by the Institutional Review Board and all participants provided informed consent.

Results

A total of 200 patients were included in the study. The mean age of the patients was 55 years and 55% were male. The most common type of surgery was spinal (60%), followed by cranial (25%) and peripheral nerve surgeries (15%). In 80% of the surgeries, IONM was used.

Intraoperative changes in IONM signals were observed in 15% of the surgeries. Of these, 70% were related to motor function and 30% were related to sensory function. The most common interventions performed in response to IONM changes were repositioning of the patient (35%), adjusting the anesthetic depth (25%), and halting the surgical procedure (20%). 

Logistic regression analysis showed that longer duration of surgery and the use of IONM were significantly associated with a higher incidence of IONM changes (p<0.05). Age, sex, and type of surgery were not significantly associated with the occurrence of IONM changes.

Variable	Group without IONM	Group with IONM	P-value
Number of patients	100	100	-
Intraoperative nerve injury	8 (8%)	2 (2%)	0.035
Surgical time (minutes)	170 (±30)	190 (±30)	<0.001
Length of hospital stay (days)	4 (±1)	4 (±1)	0.7
Postoperative complications	12 (12%)	11 (11%)	0.9