The Management of Intraoperative Spinal Cord Injury – A Scoping Review

Intraoperative spinal cord injury (ISCI) is a rare but serious complication of spine surgery. This review summarizes information on checklists and algorithms for responding to IONM alerts and management of ISCIs. Intraoperative neuromonitoring (IONM) is widely used during spine surgery to continuously monitor spinal cord function. IONM techniques combine somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs), as well as electromyography (EMG). Responding to intraoperative neuromonitoring changes involves anesthesiologic, neurophysiological/technical, and surgical management strategies. Checklists can improve adherence to critical management steps in these situations.

• 1
  Management strategies for ISCIs are divided into anesthesiologic, neurophysiological/technical, and surgical categories. Anesthesiologic considerations include anesthetic regimen, blood pressure, body temperature, and blood volume.
• 2
  Neurophysiological and technical considerations involve electrode setup, stimulation parameters, and patient positioning. Electrode disconnections and electrical interferences are common technical issues.
• 3
  Surgical considerations include traction and deformity correction, hardware malposition, and team communication. Distractive forces on the spinal cord should be reversed if ISCI occurs during deformity correction.