Positioning-Related Peripheral Nerve Injury During Spine Surgery and the Role of Intraoperative Neuromonitoring

Abstract

which allows for access to relevant anatomy. However, spine surgery often requires positions that would not be well tolerated for a prolonged period in an awake patient. Such positions can place abnormal forces upon different aspects of the patient’s anatomy, including peripheral nerves. Prolonged operative duration or improper positioning can therefore produce perioperative peripheral nerve injury (PPNI). The incidence of PPNI in a heterogeneous mix of surgical cases has been reported as 0.03%, although orthopedic and neurosurgical procedures may be associated with significantly increased risk. PPNI has a significant impact on patient quality of life and frequently leads to malpractice claims; however a specific mechanism of injury is not identified in the majority of claims related to PPNI. Prevention, and early detection and intervention, is paramount to reducing PPNI and associated adverse outcomes and malpractice claims. The use of intraoperative neuromonitoring (IONM) theoretically allows the surgical team to detect and intervene on impending PPNI during surgery. We review the current literature on PPNI and explore the extent to which IONM may help prevent such injuries.