• Jefferson Walter Daniel, Ricardo Vieira Botelho, Jerônimo Buzetti Milano, Fernando Rolemberg Dantas, Franz Jooji Onishi, NetoEloy RusafaERNeurosurgeon - University of São Paulo (USP), São Paulo-SP, Brazil., BertoliniEduardo de FreitasEFNeurosurgeon, Hospital do Servidor Público Estadual, São Paulo-SP, Brazil., Marcelo Antonio Duva Borgheresi, and Andrei Fernandes Joaquim.
• Neurosurgeon, Santa Casa de São Paulo - School of Medical Sciences, São Paulo, Brazil.
• Spine. 2018 Aug 1; 43 (16): 115411601154-1160.

Study DesignSystematic literature review and meta-analysis.ObjectiveThe objective of this systematic literature review was to evaluate if intraoperative neurophysiological monitoring (IONM) can prevent neurological injury during spinal operative surgical procedures.Summary Of Background DataIONM seems to have presumable positive effects in identifying neurological deficits. However, the role of IONM in the decrease of new neurological deficits remains unclear.MethodsUsing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and Meta-analysis, we reviewed clinical comparative studies who evaluate the rate of new neurological events in patients who had a spinal surgery with and without IONM. Studies were then classified according to their level of evidence. Methodological quality was assessed according to methodological index for non-randomized studies instrument.ResultsSix studies were evaluated comparing neurological events with and without IONM use by the random effects model. There was a great statistical heterogeneity. The pooled odds ratio (OR) was 0.72 {0.71; 1.79}, P = 0.4584. A specific analysis was done for two studies reporting the results of IONM for spinal surgery of intramedullary lesions. The OR was 0.1993 (0.0384; 1.0350), P = 0.0550.ConclusionIONM did not result into fewer neurological events with the obtained evidence of the included studies. For intramedullary lesions, there was a trend to fewer neurological events in patients who underwent surgery with IONM. Further prospective randomized studies are necessary to clarify the indications of IONM in spinal surgeries.Level Of Evidence2.

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