Monitoreo neurofisiológico intraoperatorio en traumatismo raquimedular cervical y columna cervical compleja: Recomendaciones desde una visión dual basada en experiencia personal

Abstract

Introduction: Complex cervical spine surgery, traumatic or of other causes, can determine a new neurological deficit even in expert hands, risk that starts from the surgical position, and even more during instrumentation or correction maneuvers. However, during these surgeries the Intraoperative Neurophysiological Monitoring (IOM) provides re-al-time functional information that could define surgical steps, and consequently, better neurological outcome. Objec-tive: To demonstrate the need to use IOM in complex cervical spine surgeries, delivering practical recommendations for these surgeries since their use. Material and Method: A prospectively collected and retrospectively analyzed study of the group of patients undergoing cervical and complex cervicothoracic spinal surgery, in whom it was nec-essary to undergo surgery under IOM, during the period 2013-2018, with emphasis on patients operated on and monitored by the author. We exclude patients who underwent a cervical disc without myelopathy. Results: During this period, a total of 1,305 patients underwent surgery under IOM, of which 217 corresponded to the cervical spine, and 142 to a complex cervical spine. Of these, in 55 the author participates as a surgical assistant and MIO, and in 37 as the first surgeon + MIO. Of these 37 patients, the traumatic cause predominates, followed by degenerative. Three patients presented significant and fall of potentials, which respond to resuscitation maneuvers, evolving without neurological deterioration. Conclusions: The IOM, in a complex cervical spine, provides information and safety that cannot be evaluated through any other tool available in Neurosurgery, determining intraoperative surgical changes and learning curve that significantly favor the surgical results.