(75-77) In a review of 11 retrospective studies assessing the efficacy of MIOM during spine surgery--all of which included MEP and nine of which combined SSEP and MEP--an overall sensitivity of 70% to 100%, specificity of 52.7% to 100%, PPV of 5.2% to 100%, and NPV of 96% to 100% were found.
(66) This case further highlights the importance of MIOM, as it documents the occurrence of selective posterior spinal cord dysfunction without injury to the anterior columns, which would have gone unnoticed with MEP monitoring alone.
While MIOM is regularly used by spine surgeons to improve patient safety, there are currently no procedure-specific MIOM guidelines.
The practice patterns demonstrate that the majority of surgeons surveyed use multi-modality monitoring during most surgeries; however, there is no consensus between the surgeons surveyed on MIOM modality combination to be used for specific procedures.
As MIOM use has yet to be well supported by high-level prospective studies, there is controversy over whether IOM use has actually affected neurological complication rates during spinal surgeries.
While MIOM is currently assumed to be cost-effective for thoracic and cervical procedures, IOM use during lumbar surgeries is more controversial, as lumbar surgeries tend to be at lower risk.