To determine reporting gaps in the existing literature and assess the effectiveness of intraoperative electrophysiological monitoring of evoked potentials in preventing spinal cord injury during aortic aneurysm procedures.

Intraoperative monitoring has become a critical component in vascular surgeries, yet inconsistent reporting and variations in monitoring protocols may compromise patient outcomes. This systematic review aims to establish clearer guidelines for monitoring practices in this context.

A systematic review and meta-analysis were conducted according to PRISMA guidelines, including original studies involving intraoperative monitoring for spinal cord protection in aortic aneurysm surgery. Databases searched included PubMed, Cochrane, and EMBASE, with strict eligibility criteria applied. Data extraction was performed by two independent reviewers, focusing on monitoring outcomes and safety.

The effectiveness of intraoperative evoked potentials (EPs) in preventing spinal cord injury (SCI) during aortic aneurysm surgery was evaluated in 26 studies. Considerable variability was noted in surgical techniques, patient demographics, and monitoring systems. Spinal cord injury incidence ranged from 1% to 3.4% in monitored cases. Sensitivity of motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) ranged from 33% to 98%, with specificity consistently above 97%. Combined SSEP and MEP monitoring demonstrated greater effectiveness in identifying and preventing SCI. Mortality rates, often related to perioperative complications, ranged from 3.8% to 5.7%. Intraoperative neurophysiological monitoring (IONM) was generally associated with a reduction in neurological deficits, with more recent studies indicating improved accuracy. However, evidence increasingly highlights the importance of EPs as a key tool for early detection of spinal cord ischemia, despite ongoing limitations in patient selection, protocol standardization, and study design variability.

The findings indicate a pressing need for standardized guidelines to enhance reporting rigor in studies involving intraoperative monitoring during aortic surgeries. Addressing these gaps will facilitate improved comparability and potentially better clinical outcomes in the management of spinal cord injuries.