Journal of Osteoporosis and Physical Activity
Open Access

Enhancing Safety in Spinal Surgery

Vincent Fehling^{* *}Correspondence: Vincent Fehling, Department of Neurosurgery and Spinal Program, University of Toronto, Toronto, Canada, Email:

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Description

Spinal surgery for fractures is an important and complex procedure that requires meticulous planning and precise execution to ensure the best outcomes for patients. One of the pivotal aspects of ensuring a successful spinal surgery is intraoperative monitoring. This process involves a range of techniques and technologies aimed at safeguarding the patient’s neurological functions, optimizing surgical outcomes, and reducing the risk of complications. Here's an overview of the importance, methods, and benefits of monitoring during spinal surgery for fractures. Spinal fractures can result from trauma, osteoporosis, tumors, or other pathological conditions. These fractures often compromise the structural integrity of the spine and may impinge on the spinal cord or nerve roots, leading to pain, neurological deficits, and disability. During surgery, it is important to maintain and protect the neural elements while stabilizing the spine. Intraoperative monitoring provides real-time feedback on the functional integrity of the spinal cord and nerves, enabling the surgical team to make informed decisions and adjust their techniques as necessary.

Methods of intraoperative monitoring

Somatosensory Evoked Potentials (SSEPs): SSEPs involve stimulating peripheral nerves and recording the electrical responses generated in the spinal cord and brain. This method assesses the sensory pathways and can detect any disruption in the neural transmission caused by surgical manipulation. A significant change in SSEPs can indicate potential damage, allowing the surgeon to modify their approach to prevent permanent injury.

Motor Evoked Potentials (MEPs): MEPs monitor the motor pathways by delivering transcranial electrical stimulation and recording the muscle responses. This technique is essential for surgeries that pose a risk to motor functions. Like SSEPs, changes in MEPs alert the surgical team to possible damage to the motor tracts, prompting immediate corrective actions.

Electromyography (EMG): EMG measures the electrical activity of muscles and is particularly useful for detecting nerve root irritation or injury. It can be performed using both free-running and triggered modes. Free-running EMG provides continuous monitoring, while triggered EMG is used to test the response of specific nerves when stimulated. This helps in identifying and protecting nerve roots during the procedure.

Pedicle screw stimulation: This technique is used during the placement of pedicle screws, which are important for spinal stabilization. By stimulating the screws, surgeons can ensure that they are correctly positioned within the pedicle and have not breached the cortical bone, which could potentially damage adjacent neural structures.

Benefits of intraoperative monitoring

The primary benefit of intraoperative monitoring is the enhanced safety it provides. By continuously assessing the functional integrity of the spinal cord and nerves, the surgical team can promptly address any issues, thereby reducing the risk of permanent neurological damage. Monitoring allows for realtime adjustments during surgery, leading to more precise and effective interventions. This contributes to better alignment and stabilization of the spine, ultimately improving patient outcomes. The ability to detect and respond to potential complications during surgery reduces the incidence of postoperative neurological deficits, such as paralysis, sensory loss, or chronic pain. This translates to faster recovery times and better overall quality of life for patients. Intraoperative monitoring provides a detailed record of the neural function throughout the surgery. This documentation can be valuable for postoperative care, research, and legal protection in case of malpractice claims.

Conclusion

Monitoring during spinal surgery for fractures is an indispensable component of modern surgical practice. The use of advanced monitoring techniques like SSEPs, MEPs, EMG, and pedicle screw stimulation ensures the safety and efficacy of the procedure. By providing real-time feedback on the functional status of the spinal cord and nerves, intraoperative monitoring helps in preventing complications, enhancing surgical precision and improving patient outcomes. As technology continues to advance, the scope and effectiveness of intraoperative monitoring will likely expand, further solidifying its role in spinal surgery.