The Hand Surgery Landscape|Articles in Press

Indications and Technique for the Use of Intraoperative Neuromonitoring in Brachial Plexus Surgery

Published:March 11, 2023DOI:
      Confirming the presence or absence of a functioning nerve root in traumatic brachial plexus injuries is vital in the surgical decision-making process. Intraoperative neuromonitoring can confirm intact rootlets with the use of motor evoked potentials and somatosensory evoked potentials. The purpose of this article is to describe the rationale and details of intraoperative neuromonitoring to provide a basic understanding of its role in decision-making in patients with brachial plexus injuries.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Carvalho G.A.
        • Nikkhah G.
        • Matthies C.
        • Penkert G.
        • Samii M.
        Diagnosis of root avulsions in traumatic brachial plexus injuries: value of computerized tomography myelography and magnetic resonance imaging.
        J Neurosurg. 1997; 86: 69-76
        • Oberle J.
        • Antoniadis G.
        • Rath S.A.
        • et al.
        Radiological investigations and intra-operative evoked potentials for the diagnosis of nerve root avulsion: evaluation of both modalities by intradural root inspection.
        Acta Neurochir. 1998; 140: 527-531
        • Clarkson J.H.W.
        • Ozyurekoglu T.
        • Mujadzic M.
        • Iyer V.
        • Breidenbach W.C.
        An evaluation of the information gained from the use of intraoperative nerve recording in the management of suspected brachial plexus root avulsion.
        Plast Reconstr Surg. 2011; 127: 1237-1243
        • Yeow Y.J.
        • Yeow K.M.
        • Su I.H.
        • et al.
        Predicting healthy C5 spinal nerve stumps eligible for grafting with MRI, tinel test, and rhomboid electromyography: a retrospective study of 295 consecutive brachial plexus surgeries.
        Radiology. 2021; 300: 141-151
      1. Zelenski NA, Oishi T, Shin AY. Intraoperative neuromonitoring for peripheral nerve surgery. J Hand Surg Am. 2023. pii:S0363-5023(22)00724-9.

        • Turkof E.
        • Millesi H.
        • Turkof R.
        • Pfundner P.
        • Mayr N.
        Intraoperative electroneurodiagnostics (transcranial electrical motor evoked potentials) to evaluate the functional status of anterior spinal roots and spinal nerves during brachial plexus surgery.
        Plast Reconstr Surg. 1997; 99: 1632-1641
        • Oberle J.
        • Antoniadis G.
        • Kast E.
        • Richter H.P.
        Evaluation of traumatic cervical nerve root injuries by intraoperative evoked potentials.
        Neurosurgery. 2002; 51: 1182-1190
        • Hattori Y.
        • Doi K.
        • Fukushima S.
        • Kaneko K.
        The diagnostic value of intraoperative measurement of choline acetyltransferase activity during brachial plexus surgery.
        J Hand Surg Br. 2000; 25: 509-511
        • Zhao S.
        • Kim D.H.
        • Kline D.G.
        • Beuerman R.W.
        • Thompson H.W.
        Somatosensory evoked potentials induced by stimulating a variable number of nerve fibers in rat.
        Muscle Nerve. 1993; 16: 1220-1227
        • Krause K.L.
        • Cheaney II, B.
        • Obayashi J.T.
        • Kawamoto A.
        • Than K.D.
        Intraoperative neuromonitoring for one-level lumbar discectomies is low yield and cost-ineffective.
        J Clin Neurosci. 2020; 71: 97-100