Next-Generation Neuromonitoring in Minimally Invasive Spine Surgery: Indications, Techniques, and Clinical Outcomes.

Publication Type	Review
Authors	Ikwuegbuenyi C, Willett N, Elsayed G, Kashlan O, Härtl R
Journal	Neurosurgery
Volume	96
Issue	3S
Pagination	S111-S118
Date Published	02/14/2025
ISSN	1524-4040
Keywords	Minimally Invasive Surgical Procedures, Intraoperative Neurophysiological Monitoring
Abstract	Neuromonitoring in minimally invasive spine surgery (MISS) provides real-time feedback to surgeons and enhances surgical precision for improved patient safety. Since the 1970s, established techniques like somatosensory evoked potentials, motor evoked potentials, and electromyography have been integrated into spine surgeries, significantly reducing the risk of neurological complications. These neuromonitoring modalities have been crucial, particularly in complex procedures with limited direct visualization. Refinements in these techniques have led to greater confidence in nerve root safety, contributing to the success of MISS. Despite some debate regarding the routine use of neuromonitoring in noncomplex surgeries, its importance in complex cases is well-documented. Studies have demonstrated high sensitivity and specificity rates for these techniques, with multimodal approaches offering the best outcomes. Advancements in mechanomyography and its potential integration into neuromonitoring protocols highlight the continuous improvement in this field. This review explores the historical development, current techniques, clinical outcomes, and future directions of neuromonitoring in MISS. It emphasizes the critical role of these technologies in enhancing surgical outcomes and patient care. As MISS continues to evolve, adopting next-generation neuromonitoring systems, including artificial intelligence and machine learning, will play a pivotal role in advancing the efficacy and safety of spine surgeries.
DOI	10.1227/neu.0000000000003330
PubMed ID	39950791