Neuromonitoring during surgery for metastatic tumors to the spine:: intraoperative interpretation and management strategies

The surgical management of metastatic tumors of the spine can be optimized with intraoperative monitoring of neurophysiology. This article describes currently available neuromonitoring techniques that can be applied to facilitate tumor resection and attendant spinal stabilization. We describe the role of somatosensory-evoked potentials and motor-evoked potentials and the use of direct stimulation to map the dorsal columns for myelotomy localization. For the rare intramedullary metastasis, direct stimulation of the spinal cord can be used to define the tumor interface, allowing for a more complete resection with minimal morbidity.