The Influence of Anesthesia on Neuromonitoring During Scoliosis Surgery: A Systematic Review

Background: Intraoperative neuromonitoring (IONM) is crucial for the safety of scoliosis surgery, providing real-time feedback on the spinal cord and nerve function, primarily through motor-evoked potentials (MEPs). The choice of anesthesia plays a crucial role in influencing the quality and reliability of these neuromonitoring signals. This systematic review evaluates how different anesthetic techniques-total intravenous anesthesia (TIVA), volatile anesthetics, and regional anesthesia approaches such as Erector Spinae Plane Block (ESPB), spinal, and epidural anesthesia-affect IONM during scoliosis surgery. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, MEDLINE, EMBASE, and Cochrane databases were searched for studies published between 2017 and 2024 that examined the impact of anesthetic techniques on neuromonitoring during scoliosis surgery. The focus was on studies reporting MEP outcomes, anesthetic protocols, and postoperative neurological and analgesic effects. Results: The search initially identified 998 articles. After applying inclusion criteria based on relevance, recency, methodological quality, and citation frequency, 45 studies were selected for detailed review. Conclusion: The erector Spinae Plane Block (ESPB) provides distinct benefits over spinal and epidural anesthesia in scoliosis surgery, particularly in maintaining neuromonitoring accuracy, reducing hemodynamic instability, and minimizing complications. The ESPB's ability to deliver effective segmental analgesia without compromising motor function makes it a safer and more efficient option for postoperative pain management, enhancing patient outcomes.