Intraoperative neurophysiological monitoring in surgical correction of neuromuscular scoliosis: clinical and methodological aspects and interpretation algorithms (narrative review)

Objective. To summarize and critically evaluate data on intraoperative neurophysiological monitoring in surgical correction of neuromuscular scoliosis with an emphasis on monitoring modalities, causes of alarm events and an algorithm of response actions.

Material and Methods. The study was carried out as a practice-oriented narrative review with an analytical synthesis of published data without conducting a formal meta-analysis; level of evidence – V. The search for sources was performed in PubMed/Medline, Scopus, Web of Science Core Collection, and the Russian Science Citation Index (RSCI) for the period from January 1, 2005 to September 22, 2025, with additional manual search.

Results. Key modalities included transcranial motor and somatosensory evoked potentials complemented by free-running and triggered electromyography (EMG) to monitor radicular events and to assess pedicle screw position. In cases of poor monitorability, epidural
responses (including D-wave) are possible as a backup tactic. Signal changes in neuromuscular scoliosis are determined by three groups of factors: perfusion–physiological, mechanical (correction maneuvers), and anesthesiological–technical. A stepwise alarm response algorithm is summarized: exclusion of technical causes, optimization of perfusion and anesthesia, assessment of relationship with the correction stage, and deciding on maneuver modification.

Conclusion. Multimodal intraoperative neurophysiological monitoring increases the safety of neuromuscular scoliosis correction; however, alarm criteria and treatment strategies should be individualized according to the underlying diagnosis, initial deficit, and stage of correction.

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