The Impact of Intraoperative Neurophysiological Monitoring on Neurological Outcomes: A Systematic Review and Meta-analysis 

The Impact of Intraoperative Neurophysiological Monitoring on Neurological Outcomes: A Systematic Review and Meta-analysis | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 14 November 2025 V1 Latest version Share on The Impact of Intraoperative Neurophysiological Monitoring on Neurological Outcomes: A Systematic Review and Meta-analysis Author : Majid Karimi Baghmaleki 0000-0002-3961-059X [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.176314003.30994826/v1 252 views 134 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Intraoperative neurophysiological monitoring (IONM) has become a fundamental adjunct in modern neurosurgery and spine surgery, allowing real-time functional assessment of neural pathways during operative procedures. Despite widespread adoption, the degree to which IONM effectively reduces postoperative neurological complications remains variably reported. This systematic review and meta-analytic synthesis aims to quantify the overall impact of IONM on patient outcomes across both cranial and spinal neurosurgical domains. Methods: A systematic search was conducted through PubMed, Scopus, and Web of Science databases for meta-analyses and high-quality cohort studies published between January 2015 and October 2025. Studies evaluating IONM’s influence on postoperative neurological deficit rates, intraoperative warning accuracy, and cost-effectiveness were included. Data were extracted and narratively synthesized, with reported pooled effect sizes integrated where available. Randomeffects models from prior meta-analyses were interpreted to estimate overall effect magnitude. Results: Across 24 meta-analyses and 68 large-scale studies comprising over 45,000 patients, IONM demonstrated a significant reduction in new postoperative neurological deficits compared with unmonitored controls (pooled Risk Ratio [RR] = 0.47; 95% CI: 0.32–0.68; p < 0.001). In spinal surgeries, multimodal IONM (SSEP + MEP ± EMG) achieved higher diagnostic accuracy (sensitivity 0.88; specificity 0.93) than single-modality monitoring. In brain tumor resections, IONM combined with awake mapping reduced permanent deficits by 25–40%. Costeffectiveness was confirmed in high-risk cases, with an estimated incremental cost-effectiveness ratio (ICER) of US$12,000 per QALY gained, well below common thresholds. Conclusions: IONM significantly improves intraoperative safety and postoperative neurological preservation in both spine and cranial neurosurgery. The magnitude of benefit is greatest in complex procedures such as deformity corrections, intramedullary spinal tumor resections, and surgeries involving eloquent brain regions. While evidence quality varies, convergence across multiple meta-analyses supports IONM as a standard of care in modern neurosurgical practice. Clinical Significance: Routine integration of multimodal IONM in complex neurosurgical cases should be considered a best-practice standard to minimize neural injury and enhance surgical outcomes. Keywords: Intraoperative neurophysiological monitoring; neurosurgery; spine surgery; motor evoked potentials; somatosensory evoked potentials; neurological deficits; meta-analysis; surgical outcomes Supplementary Material File (the impact of intraoperative neurophysiological monitoring on neurological outcomes.pdf) Download 296.59 KB Information & Authors Information Version history V1 Version 1 14 November 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords intraoperative neurophysiological monitoring meta analysis motor evoked potentials neurosurgery spine surgery Authors Affiliations Majid Karimi Baghmaleki 0000-0002-3961-059X [email protected] View all articles by this author Metrics & Citations Metrics Article Usage 252 views 134 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Majid Karimi Baghmaleki. The Impact of Intraoperative Neurophysiological Monitoring on Neurological Outcomes: A Systematic Review and Meta-analysis . Authorea . 14 November 2025. DOI: https://doi.org/10.22541/au.176314003.30994826/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); Cited by Loading... 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