{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T07:56:24Z","timestamp":1787903784132,"version":"build-2784847793"},"reference-count":64,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T00:00:00Z","timestamp":1709596800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: A practical solution to the incidental unreliability of intraoperative neuromonitoring (IONM) may be the simultaneous neurophysiological recording and control of the surgical field through a camera (the concept of \u201cReal-time\u201d IONM). During \u201cReal-time\u201d IONM, the surgeon is immediately warned about the possibility of damage to the neural structures during, but not after, standard idiopathic scoliosis (IS) corrective surgery procedures (the concept of \u201cSurgeon\u2013neurophysiologist\u201d interactive, verbal IONM). This study aimed to compare the advantages, utilities, reliabilities, and time consumption of the two IONM scenarios. Methods: Studies were performed in two similar groups of patients undergoing surgery primarily due to Lenke 2 idiopathic scoliosis (N = 120), when both IONM approaches were applied. Neurophysiological evaluations of the spinal transmission were performed pre- (T0), intra- (before (T1) and after (T2) surgery), and postoperatively (T3), as well as once in healthy volunteers (control, N = 60). Non-invasive and innovative recordings of the motor evoked potentials (MEPs) bilaterally from the peroneal (PER) nerve and tibialis anterior (TA) muscle were performed with surface electrodes as a result of transcranial magnetic stimulation (TMS) or electrical stimulation (TES) at T0\u2013T3. Results: In both groups, the MEP amplitudes and latencies recorded from the PER nerve were approximately 67% lower and 3.1 ms shorter than those recorded from the TA muscle. The MEP recording parameters differed similarly at T0\u2013T3 compared to the control group. In all patients, the MEP parameters induced by TMS (T0) and TES (T1) did not differ. The MEP amplitude parameters recorded from the TA and PER at T1 and T2 indicated a bilateral improvement in the neural spinal conduction due to the surgical intervention. The TMS-induced MEP amplitude at T3 further increased bilaterally. In both IONM groups, an average 51.8 BIS level of anesthesia did not affect the variability in the MEP amplitude, especially in the PER recordings when the applied TES strength was 98.2 mA. The number of fluctuations in the MEP parameters was closely related to the number of warnings from the neurophysiologist during the transpedicular screw implantation, corrective rod implantation, and distraction, derotation, and compression procedures, and it was higher in the \u201cSurgeon\u2013neurophysiologist\u201d IONM group. The average duration of surgery was shorter by approximately one hour in the \u201cReal-time\u201d IONM group. The number of two-way communications between the surgeon and the neurophysiologist and vice versa in the \u201cReal-time\u201d IONM group decreased by approximately half. Conclusions: This study proves the superiority of using \u201cReal-time\u201d IONM over the standard \u201cSurgeon\u2013neurophysiologist\u201d IONM procedure in increasing the safety and non-invasiveness, shortening the time, and lowering the costs of the surgical treatment of IS patients. The modifications of the MEP nerve-conduction-recording technology with surface electrodes from nerves enable precise and reliable information on the pediatric patient\u2019s neurological condition at every stage of the applied surgical procedures, even under conditions of slight fluctuations in anesthesia.<\/jats:p>","DOI":"10.3390\/jcm13051497","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T05:31:19Z","timestamp":1709616679000},"page":"1497","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["\u201cReal-Time Neuromonitoring\u201d Increases the Safety and Non-Invasiveness and Shortens the Duration of Idiopathic Scoliosis Surgery"],"prefix":"10.3390","volume":"13","author":[{"given":"Przemys\u0142aw","family":"Daroszewski","sequence":"first","affiliation":[{"name":"Department of Organization and Management in Health Care, Pozna\u0144 University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-0497","authenticated-orcid":false,"given":"Juliusz","family":"Huber","sequence":"additional","affiliation":[{"name":"Department Pathophysiology of Locomotor Organs, Pozna\u0144 University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6421-7909","authenticated-orcid":false,"given":"Katarzyna","family":"Kaczmarek","sequence":"additional","affiliation":[{"name":"Department Pathophysiology of Locomotor Organs, Pozna\u0144 University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Janusz","sequence":"additional","affiliation":[{"name":"Department of Spine Disorders and Pediatric Orthopaedics, Pozna\u0144 University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pawe\u0142","family":"G\u0142\u00f3wka","sequence":"additional","affiliation":[{"name":"Department of Spine Disorders and Pediatric Orthopaedics, Pozna\u0144 University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Tomaszewski","sequence":"additional","affiliation":[{"name":"Department of Spine Disorders and Pediatric Orthopaedics, Pozna\u0144 University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0810-9361","authenticated-orcid":false,"given":"Tomasz","family":"Kotwicki","sequence":"additional","affiliation":[{"name":"Department of Spine Disorders and Pediatric Orthopaedics, Pozna\u0144 University of Medical Sciences, 28 Czerwca 1956 r. Street, No. 135\/147, 61-545 Pozna\u0144, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11832-012-0458-3","article-title":"Idiopathic scoliosis: Etiological concepts and hypotheses","volume":"7","author":"Dayer","year":"2013","journal-title":"J. Childr. 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