Neuromonitoring for cervical disc surgery: Concepts and controversies

One of the most widely used and increasingly prevalent tools during spine surgery is intraoperative neuromonitoring (IONM). IONM can provide the spine surgeon with real-time feedback of possible neurologic insult, potentially allowing for immediate interventions that decrease iatrogenic injury. Despite the proven utility in scoliosis surgery, the value of IONM during cervical disc surgery remains unclear. For cervical patients with myelopathic symptoms or risk of spinal cord injury, IONM may lead to intervening strategies that could alter outcome, however, data to support its routine use is sparse. For non-myelopathic patients undergoing ACDF, IONM does not necessarily reduce neurologic complications and substantially increases the overall cost of care.