Use of intraoperative neurophysiological monitoring during epiduroscopy as a safety measure.

OBJECTIVE

In this study, we present the first 12 cases of the use of intraoperative neurophysiological monitoring (IONM) during therapeutic epiduroscopy in patients with clinical canal stenosis.

METHODS

IESS was performed using two working instruments: an epidural balloon to dilate the epidural space without damaging the nerve structures (Resaloon®) and an element to perform flavotomy of the ligamentum flavum (Resaflex®). The procedure was performed at levels of the greatest stenosis, as detected using preoperative magnetic resonance imaging.

RESULTS

Of the 12 cases that used IONM, 2 patients presented neurotonic activity in roots during ligamentum flavum ablation, 1 patient presented neurotonic activity while using Resaloon® in a root contralateral to the level at which the procedure was conducted, and other presented neurotonic activity in a root below the level at which the ligamentum flavum was ablated. In all cases, potentially harmful discharges stopped when the procedure was interrupted momentarily.

CONCLUSIONS

Intraoperative neurophysiological monitoring detected alterations in surgical field and roots below and/or contralateral to the field, which disappeared with complete recovery after interrupting the procedure; this can avoid the possible prolonged or even permanent complications postoperatively.

SIGNIFICANCE: Intraoperative neurophysiological monitoring during epiduroscopy is safe, thus optimizing surgical outcomes.