Intraoperative Neurophysiological Monitoring in Spine Surgery in Pediatric Population

Abstract

Intraoperative neurophysiological monitoring (IONM) has become an essential adjunct in pediatric spine surgery for prevention of iatrogenic neurological injury during correction of spinal deformities, congenital anomalies, and complex spinal procedures. Pediatric patients represent a unique challenge because of immature neural pathways, variable anesthetic responses, and complex deformity patterns, which may affect monitoring reliability. Multimodal IONM, including somatosensory evoked potentials, motor evoked potentials, and electromyography, provides real-time assessment of sensory and motor pathway integrity and improves intraoperative detection of impending neurological compromise. Recent advances have expanded its indications, refined alert-response algorithms, and strengthened multidisciplinary strategies for signal interpretation and intervention. This review highlights the current role of IONM in pediatric spine surgery, focusing on monitoring modalities, indications, intraoperative alert management, technical challenges, and contemporary evidence regarding its effectiveness in improving surgical safety and neurological outcomes.