| Diagnostic value |
| I | 2015 | 25 | Tumorectomy (Intramedullary) | Retrospective | SSEP/MEP Free-run EMG | MINM has 100% sensivity, 91% specificity, 60% PPV, and 100% NPV (using all-or-none warning criteria for MEP). ‘All-or-none’ criteria showed the higher accuracy than ‘>50% decrement of amplitude’ for the prediction of long-term outome. | [47] |
| III | 2015 | 75 | Cervical spine surgery | Retrospective | SSEP/MEP Free-run EMG | Five patients showed the loss of MEP during neck positioning. Four of 5 had compete recovery of MEP after repositioning, but one failed to recover resulting in the post-operative neurologic deficit. | [55] |
| II | 2014 | 1,162 | Deformity correction | Retrospective | MEP | The new warning criteria (>80% amplitude reduction) yields a very low false-positive rate (0.26%) and PPV of 83.3%. | [16] |
| II | 2013 | 103 | Spinal tumor & myelopathy | Prospective | SSEP/MEP/D-wave | D-wave was feasible in 97 cases. A stable D-wave recording correctly predicted good motor outcome in allrecordable cases. The one case which showed the increase of D-wave amplitude during the surgery revealed the improvement of post-operative motor function. | [46] |
| I | 2012 | 175 | Deformity correction | Retrospective | SSEP/MEP | MINM sensitivity/specificity; 92.9%/99.4%, MEP alone (warning criteria; >75% reduction of amplitude) ensitivity/specificity; 91.7%/ 98.8%, SSEP alone sensitivity/specificity; 50%/ 95.2%. | [45] |
| I | 2007 | 52 | Cervical myelopathy | Retrospective | SSEP/MEP | MEP (warning criteria; >80% reduction of amplitude) sensivity and specificity were 100% and 90% versus 0% and 100% for SSEP. The PPV of MEP was 17% (5 of 6 events were false positive). | [3] |
| I | 2007 | 1,017 | Spine surgery | Prospective | SSEP/MEP Free-run EMG | MINM sensitivity and specificity were 89% and 99% respectively with 8 false negatives. Lumbar spine decompression operations accounted for 40% of false positive cases. | [56] |
| III | 2006 | 57 | Laminoplasty | Prospective | MEP | No cases showed the decrement of MEP during the surgery, but 3 had post-operative C5 palsy (transient). | [57] |
| I | 2004 | 427 | Cervical spine surgery | Retrospective | SSEP/MEP | MEP sensitivity and specificity were 100%, while SSEP were 100% specific but only 25% sensitive. | [2] |
| II | 2002 | 97 | Spine surgery | Prospective | SSEP/MEP | The 16 patients revealed the significant signal change during the surgery. Six of 16 patients had new post-operative neurologic deficits while there were no deficits in cases with normal waves during the surgery. | [44] |
| II | 1995 | 51,263 | Spine surgery | Survey | SSEP | True negatives ratio was 98%, false negative ratio. 0.13%, true positive ratio. 0.42%, and false positive ratio. 1.5%. | [43] |
| III | 1989 | 20 | Cervical spine surgery | Retrospective | MEP | One new postoperative deficit was predicted by the complete loss of MEP, while 5 cases showed transient attenuation of MEP without the post-operative neurologic deficit. (sensitivity 100%; specificity 74%). | [42] |
| III | 1984 | 137 | Deformity correction | Retrospective | SSEP | SSEP deterioration were seen in 69 cases. The new post-operative neurologic deficits were obtained in cases of the sustained worsening of both amplitude and latency of waves. | [41] |
| Therapeutic value |
| III | 1988 | 295 (150/145) | Thoracolumbar spine injury | Retrospective | SSEP | The of 145 (6.9%) control group had new post-operative deficits, while one of 150 (0.7%) developed a new deficit in the monitored group. | [58] |
| III | 1993 | 171 (51/120) | Decompressive surgery (OPLL) | Retrospective | SSEP | No post-operative deficits occurred in the present case series with SSEP monitoring, which was superior to histrocial control groups. | [48] |
| III | 2006 | 1,445 | Cervical spine surgery | Retrospective | SSEP/MEP Free-run EMG | MINM detected post-operative neurologic damage in 2 patients out of 267 alerts. Eight operations were aborted d/t significant EP changes without any new deficits. | [59] |
| III | 2006 | 100 (50/50) | Tumorectomy (intramedullary) | Retrospective | SSEP/MEP/D-wave | MINM group had better mean McCormick grade improvement than control group at 3-month follow-up. (+0.28 vs －0.16, p = 0.0016). | [23] |
| III | 2010 | 32 articles | Spine surgery | Systematic review | | Very low-level evidence; Intervention itself responding to an INM alert during surgery reduces the rate of the development of neurologic damage. | [49] |
| III | 2012 | 720 | Cervical spine surgery | Retrospective | N/A | Only three patients (0.4%) showed a new, transient post-operative neurological deficit. Cost savings was estimated at $1024,754. | [51] |
| III | 2013 | 12,375 | Spine surgery | Retrospective | SSEP/MEP neurogenic MEP, Free-run/Triggered EMG | Intraoperative interventions made improvement in 360 alerts out of 406. One patient revealed a new deficitcompared with 14 deficits of which alerts failed to recover after intervention. (MINM reduced the risk of development of neurologic deficit from 3.1% to 0.12%) | [50] |
| II | 2014 | 76 (50/26) | Tumorectomy (intramedullary) | Retrospective | SSEP/MEP | The use of INM did not change the result of the rate of gross total resection or the neurologic outcome. | [52] |
| II | 2017 | 101 (41/70) | Tumorectomy (IDEM) | Retrospective | MEP, SSEP | There was no statistically significant difference in the rate of new postoperative neurologic deficit between the monitored and unmonitored group (10% vs 14%). | [53] |