Consideration for Spinal Cord Monitoring of Patients with Cervical Injuries

Intraoperative neurophysiologic monitoring has evolved from the Stagnara wakeup test to real-time feedback continuous recordings. Somatosensory-evoked potential monitoring has been used in scoliosis surgery for decades with documented effectiveness in limiting potential iatrogenic neurological injury. The usefulness of intraoperative monitoring in other fields of spinal surgery, including cervical spine trauma, is still debated. Multimodality techniques that include motor-evoked potentials and spontaneous electromyography are highly sensitive, but their role in cervical spine surgery is ill defined. This report reviews current concepts, literature, and recommendations on the use of intraoperative neurophysiologic monitoring in cervical spine trauma patients.