Prevention of Neurological Damage in Severe Cervical Stenosis: The Role of Intraoperative Monitoring and Proactive Measures

Abstract

Cervical stenosis is a degenerative condition that causes compression of the spinal cord and nerve roots, resulting in neurological symptoms such as pain, weakness, and loss of motor and sensory function. Surgical treatment, such as spinal decompression, is indicated for severe cases, as untreated compression may lead to irreversible damage. Intraoperative neurophysiological monitoring (IONM) has proven essential for patient safety, allowing early detection of neurological changes and enabling immediate intervention. This article discusses the importance of IONM in severe cervical stenosis surgeries, highlighting preventive measures to minimize neurological damage. We report the case of a 57-yearold patient with severe cervical stenosis associated with myelopathy. A posterior surgical approach was chosen, with decompression and fusion, utilizing IONM to monitor motor potentials. Proactive measures, such as warm saline irrigation and maintenance of a mean arterial pressure (MAP) of 90 mmHg, were implemented to prevent neurological deterioration. After decompression, motor potentials returned to baseline levels, and the patient recovered without new neurological deficits. We conclude that IONM, combined with preventive strategies, is crucial in reducing the risk of neurological damage during severe cervical stenosis surgeries, ensuring greater patient safety.