Intraoperative neurophysiologic monitoring during spinal osteotomies

The Smith-Petersen osteotomy/Ponte osteotomy, pedicle subtraction osteotomy, cervical extension osteotomy, and vertebral column resection procedures have a high risk of neurologic complications because of blood loss, high correction forces, and numerous opportunities for direct spinal cord injury. Intraoperative neurophysiologic monitoring with a combination of motor evoked potentials, somatosensory evoked potentials, and electromyography permits real-time analysis of possible nerve irritation/damage. Management, including stabilizing mean arterial pressure, decreasing or reversing the corrected kyphotic deformity, and ordering a Stagnara wake-up test to confirm the neurologic status can provide the immediate response necessary to minimize neurologic complications.