To optimally preserve the neural structures during spinal surgery, an interdisciplinary effort among the surgical, neuromonitoring, and neuroanesthesia teams is imperative. The most frequently used modalities for spinal procedures are SSEPs, MEPs, freerun or spontaneous EMG (sEMG), and triggered EMG (tEMG). Several electrophysiological modalities are currently available for monitoring various aspects of the central and peripheral nervous system, each offering a unique set of benefits, limitations, and sensitivity/specificity as diagnostic techniques. During spinal surgery, several structures are placed at risk for potential injury, including the spinal cord, nerve roots, lumbar plexus, and all relevant vascular supply to these elements. I ntraoperative neurophysiological monitoring is a continually evolving field that aims to localize and monitor neural structures according to their functional basis and ultimately preserve their structural integrity. As many spinal surgeries continue to evolve along a pathway of minimal invasiveness, it is quite likely that the value of neuromonitoring will only continue to become more prominent. Thorough knowledge of the benefits and limitations of each modality helps in optimizing the diagnostic value of intraoperative monitoring during spinal procedures. Multimodality neuromonitoring relies on the strengths of different types of neurophysiological modalities to maximize the diagnostic efficacy in regard to sensitivity and specificity in the detection of impending neural injury. Finally, key clinical recommendations for the interpretation and step-wise decision-making process for intervention are discussed. Also discussed are the major benefits and limitations of each modality, as well as the strength of each alone and in combination with other modalities, with regard to its sensitivity, specificity, and overall value as a diagnostic tool. The methodology of obtaining and interpreting data from various neuromonitoring modalities-such as somatosensory evoked potentials, motor evoked potentials, spontaneous electromyography, and triggered electromyography-is reviewed in this report. Neuromonitoring provides an opportunity to assess the functional integrity of susceptible neural elements during surgery. Spinal surgery involves a wide spectrum of procedures during which the spinal cord, nerve roots, and key blood vessels are frequently placed at risk for injury.

Emg cervical spine