Multimodal intraoperative neuromonitoring (IONM) is recommended as an effective way to avoid permanent neurologic injury during surgical procedures 1).
A meta-analysis was not possible due to the heterogeneity of the studies.
Eighteen recommendations were issued and will support the adequate use of the IONM 2).
During the last 20 years several less-invasive anterior approaches to the lumbar spine have become standard, including the extreme Lateral retroperitoneal transpsoas approach. Although it is associated with a lower risk of vascular injury compared with anterior midline approaches, neuromonitoring is considered mandatory to avoid neurologic complications.