REVIEW
Introdução: A Monitorização Neurofisiológica Intraoperatória (MNIO) na cirurgia de hérnia de disco cervical é controversa. Enquanto alguns a consideram essencial para a segurança, outros questionam seu custo-efetividade, especialmente em casos de baixo risco. Esta revisão sistemática avalia as evidências sobre a eficácia, indicações e custo-benefício da MNIO na microdiscectomia cervical. Objetivo: Avaliar criticamente as evidências atuais sobre a eficácia, indicações e relação custo-benefício da MNIO durante a microdiscectomia cervical. Métodos: Revisão sistemática nas bases de dados PubMed/MEDLINE, SciELO, LILACS, WoS e BVS de janeiro de 2015 a agosto de 2025. Foram incluídos ensaios clínicos, estudos de coorte e análises de bancos de dados que compararam desfechos de pacientes submetidos à cirurgia com e sem MNIO. Resultados: A MNIO multimodal demonstrou alta sensibilidade (85-100%) e especificidade (95-100%) para detectar alterações neurológicas, sendo mais útil em casos de alto risco (mielopatia, múltiplos níveis, revisão). Grandes estudos não mostraram diferença significativa em complicações neurológicas para cirurgias de baixo risco. Conclusão: A MNIO é uma ferramenta eficaz para aumentar a segurança na cirurgia de hérnia de disco cervical, com forte recomendação em pacientes de alto risco. Em casos de baixo risco, a decisão deve ser individualizada, considerando o perfil do paciente, a experiência da equipe e os custos.
Introduction: Intraoperative Neurophysiological Monitoring (IONM) in cervical disc herniation surgery is controversial. While some consider it essential for safety, others question its cost-effectiveness, especially in low-risk cases. This systematic review evaluates the evidence on the efficacy, indications, and cost-benefit of IONM in cervical microdiscectomy. Objective: To critically evaluate current evidence regarding the efficacy, indications, and cost-effectiveness of IONM during cervical microdiscectomy. Methods: A systematic review was conducted using PubMed/MEDLINE, SciELO, LILACS, Web of Science, and VHL databases, for studies from January 2015 to August 2025. Clinical trials, cohort studies, and database analyses comparing outcomes of patients with and without IONM were included. Results: Multimodal IONM showed high sensitivity (85-100%) and specificity (95-100%) in detecting neurological changes, being more useful in high-risk cases (myelopathy, multi-level, revision). Large database studies showed no significant difference in neurological complications for low-risk surgeries. Conclusion: IONM is an effective tool for enhancing safety in cervical disc herniation surgery, with a strong recommendation for high-risk patients. In low-risk cases, the decision should be individualized, considering the patient’s profile, the surgical team’s experience, and costs.
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1Department of Neurology and Neurosurgery, Hospital São Lucas, Campo Largo, PR, Brazil.
2Hospital São Lucas, Campo Largo, PR, Brazil.
Received Oct 12, 2025
Accepted Nov 2, 2025
