{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T07:12:46Z","timestamp":1778829166698,"version":"3.51.4"},"reference-count":10,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n Intraoperative Neural Monitoring (IONM) is mandatory for performing anterior (i.e., transthoracic) or lateral extracavitary approaches to significant anterior\/anterolateral thoracic ossification of the posterior longitudinal ligament (TOPLL) (i.e. often misdiagnosed as calcified Thoracic Disc Herniations) (TDH). Notably, the remaining \u201cposterior procedures\u201d (i.e. laminectomy, transpedicular, and costotransversectomy) are contraindicated for treating significant anterior\/anterolateral TOPLL as they result in unacceptably high frequencies of spinal cord injury (SCI) typically correlated with significant intraoperative IONM losses.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A review of multiple studies documented that IONM (i.e. especially Tc-MEP (Transcranial Motor Evoked Potentials)) is mandatory when performing anterior transthoracic or lateral extracavitary approaches to TOPLL. This is because IONM alerts signaling the onset of SCI may likely be remediated (i.e. minized vs. limited) utilizing appropriate resuscitative maneuvers. Alternatively, extremely high frequencies of significant IONM losses occurring with \u201cposterior procedures\u201d carried a much higher risk of permanent\/irreversible neurological injury.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Multiple studies documented that IONM should be used with anterior transthoracic or lateral extracavitary approaches to anterior\/anterolateral TOPLL surgery, and that \u201cposterior procedures\u201d were largely contraindicated. In one series, significant amplitude Tc-MEP losses occurred in 73% of posterior decompressions; 39% developed Tc-MEP amplitude losses, that correlated with new SCI. In another study of 249 TOPLL patients undergoing \u201cposterior only operations\u201d, 50 developed new significant IONM alerts (i.e. of deterioration); only 40% (20\/50) were successfully resuscitated. Overall, initiating immediate resuscitative maneuvers in response to IONM occurring during various types of TOPLL surgery can avert SCI in up to 10.4%, to 40%, to 57% of cases.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n IONM is mandatory for anterior\/anterolateral TOPLL surgery utilizing anterior transthoracic or lateral extracavitary approaches.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_458_2026","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T06:48:39Z","timestamp":1778827719000},"page":"282","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perspective\/short review: Mandatory intraoperative neurological monitoring (IONM) for thoracic ossification of the posterior longitudinal ligament (OPLL)"],"prefix":"10.25259","volume":"17","author":[{"given":"Nancy E.","family":"Epstein","sequence":"first","affiliation":[{"name":"Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook, NY, c\/o Dr. Marc Agulnick 1122 Franklin Avenue Suite 106, Garden City, NY 11530, USA and Editor-in-Chief Surgical Neurology International"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc A.","family":"Agulnick","sequence":"additional","affiliation":[{"name":"Assistant Clinical Professor of Orthopedics, NYU Langone Hospital Long Island, NY, USA, 1122 Franklin Avenue, Suite 106, Garden City, NY 11530, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"10.25259\/SNI_458_2026\/ref-1","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1007\/s00590-019-02435-1","article-title":"Wave changes in intraoperative transcranial motor-evoked potentials during posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament","volume":"29","author":"Ando","year":"2019","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"10.25259\/SNI_458_2026\/ref-2","doi-asserted-by":"crossref","first-page":"70","DOI":"10.23736\/S0390-5616.20.04938-3","article-title":"Giant calcified thoracic disk herniations: Ossification of PLL or autonomous entity?","volume":"68","author":"D\u2019Aliberti","year":"2024","journal-title":"J Neurosurg Sci"},{"key":"10.25259\/SNI_458_2026\/ref-3","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/21925682231190613","article-title":"Definition, frequency and risk factors for intra-operative spinal cord injury: A knowledge synthesis","volume":"14","author":"Fehlings","year":"2024","journal-title":"Global Spine J"},{"key":"10.25259\/SNI_458_2026\/ref-4","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1097\/01.bsd.0000171628.93245.13","article-title":"False negative in spinal cord monitoring using spinal cord-evoked potentials following spinal cord stimulation 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