Perspective: Triple intraoperative neurophysiological monitoring (IONM) should be considered the standard of care (SOC) for performing cervical surgery for ossification of the posterior longitudinal ligament (OPLL)

Background: Triple Intraoperative Neurophysiological Monitoring (IONM) should be considered the standard of care (SOC) for performing cervical surgery Ossification Posterior Longitudinal Ligament (OPLL). IONM’s three modalities and their alerts include; Somatosensory Evoked Potentials (SEP: =/> 50% amplitude loss; =/>10% latency loss), Motor (MEP: 70% =/>10-15% Electromyography (loss EMG, including active triggered EMG (t-EMG)). Methods: During OPLL operations, 3 IONM together better detect intraoperative surgical errors, enabling spine surgeons to immediately institute appropriate resuscitative measures minimize/avoid permanent neurological deficits/injuries. Results: This focused review literature regarding showed that SEP, MEP, monitoring used reduced incidence new nerve root (e.g., mostly C5 but other palsies), brachial plexus injuries (i.e., usually occurring during operative positioning), and/or spinal cord one study patients documented a 3.79% deficits utilizing triple vs. higher 14.06% frequency without IONM). Conclusions: (i.e . , EMG) surgery. However, positive impact on outcomes critically relies surgeons’ immediate response alerts/significant deterioration with limit/avert deficits.