Nurhak DEMİR
Cyprus Journal of Medical Sciences - 2026;11(4):243-252
Neurological injury remains one of the most serious complications of spine surgery. Intraoperative neurophysiological monitoring (IONM) provides continuous, real-time functional assessment of the spinal cord and nerve roots, and is increasingly integrated into spinal procedures to mitigate the risk of perioperative neurological deficits. The principal IONM modalities used in spine surgery include motor evoked potentials (MEPs), somatosensory evoked potentials (SSEPs), electromyography (EMG), and spinal cord and nerve root mapping. MEPs are highly sensitive to dysfunction of the corticospinal tracts; SSEPs evaluate the integrity of the dorsal column-medial lemniscal pathway; EMG detects nerve root irritation or injury; and mapping techniques facilitate safe surgical navigation, particularly when anatomical landmarks are distorted or obscured. Each modality interrogates distinct neural pathways and is characterized by specific strengths and inherent limitations. When appropriately selected, systematically applied, and accurately interpreted, multimodal IONM enhances intraoperative decision-making, improves surgical safety, and supports maximal safe resection-particularly during high-risk procedures such as spinal deformity correction, intramedullary spinal cord tumor resection, and operations involving the conus medullaris or cauda equina. This review delineates the underlying neurophysiological principles and alarm criteria of these modalities, examines anesthetic considerations that influence signal reliability, and synthesizes current evidence regarding their clinical applications across diverse spinal procedures.
