Influence of intraoperative neurophysiological monitoring on the procedural lengths of posterior lumbar fusion for degenerative diseases of the lumbar spine

The use of intraoperative neurophysiological monitoring (IONM) increases the total duration (TD) of spinal fusions (SF). An increase in TD of SF is a risk factor for the development of early postoperative complications (EPOC).

AIM OF THE STUDY. Investigation of IONM influence on the TD of SF for degenerative diseases of the lumbar spine (DDLS) and, in particular, on the duration of screw placement (SP), as well as on the incidence of EPOC.

METHODS. The study included 358 patients who underwent SF for DDLS at the neurosurgical department of the Regional Clinical Hospital for the period 2019–2021. Patients were divided into 2 groups: group 1 — operated with IONM — 109 people (30.5 %), group 2 — without IONM — 249 people (69.6 %). There were no statistically significant differences between the groups in terms of age (p=0.061), gender (p=0.082), body mass index (p=0.130), nosological forms (p=0.788) and volume of surgery (p=0.515).

RESULTS. For the group 1 TD of 4-screw SF was 197.3±52.9 min, 6-screw SF — 261.9±47.1 min; for the group 2 TD of 4-screw SF was 178.4±43.7 min (p<0.01), 6-screw SF — 234.9±55.4 min (p<0.05). SP duration in group 1 for 4-screw SF was 60.0 ± 22.5 min, for 6-screw SF — 76.7 ± 28.6 min; in group 2 for 4-screw SF — 48.7 ± 22.0 min (p<0.001), for 6-screw SF — 58.1 ± 18.1 min (p<0.01). Reoperation needed EPOC were significantly more common in group 2 (3.21 %) than in group 1 (0 %) (p<0.05).

CONCLUSION. IONM using significantly increases TD of SF by 18.9–27.0 min and increases the SP duration by 11.3–18.6 min, depending on the length of the stabilizing system. Revision needed EPOC was significantly more common in the group without IONM.

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