March 28, 2012
Cynthia Harden, MD
The American Academy of Neurology recommends monitoring the spinal cord during spinal surgery and certain chest surgeries to help prevent paralysis or loss of muscle function related to the surgeries, according to an updated guideline published recently in Neurology, the academy's medical journal.
This report, which I cowrote, provides the most comprehensive and compelling evidence that intraoperative monitoring is associated with fewer catastrophic neurologic events during spinal surgery. The importance of intraoperative monitoring by a neurologist is clearly shown through the multiple studies analyzed in the journal. Effective intraoperative monitoring is complex, and requires coordination between the monitoring neurologist, surgeon, anesthesiologist and the entire surgical team. It encompasses detecting changes in the neurophysiologic studies during the operations and then responding appropriately to protect the patient from neurologic injury.
In this analysis, we evaluated only the clearest, most serious neurologic risks from spinal surgery, which were severe weakness or paralysis on one side, in the legs only or in all four limbs. Intraoperative monitoring reliably detected that there was a risk of these neurologic problems occurring during the operation, which makes it a valuable and useful procedure.
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