Introduction: Multimodal intraoperative monitoring (MIOM) is a combination of neurophysiological techniques that simultaneously evaluate ascendent and descendent spinal tracts, as well as nerve roots, to preserve their integrity during various spinal surgeries. Although these techniques had been used worldwide for many years , there are few publications on their use and diagnostic power in Latin America.
Objectives: To evaluate the sensitivity and specificity of the different techniques of MIOM  in preventing mielorradicular damage in spinal surgeries.
Material and methods: Retrospective analysis of  MIOM from 1890 spinal surgeries performed between 2002 and 2012 in different centers, 432 was pediatric patients with a mean of 12 years . MIOM included somatosensory evoked potentials ( SSEP ) , motor evoked potentials (MEP ) , free run electromyography (EMG) with root or pedicle screws stimulation, and eventually,  epidural potentials. True and false positives and negatives were analyzed .
Results: The surgeries performed were mainly scoliosis 57.5%, followed by cervical 21.3% , lumbar 10.6%, thoracic 8.3% and others, including tumors or tethered cord 2.3%. MIOM sensitivity was 93% and specificity  97.5 %.
Conclusions: MIOM , adapted in each case to the type of surgery and its potential neurological damage , can be performed easily and reliably, with high diagnostic power , so its use in spinal surgeries is essential . Having an unified MIOM protocol for each procedure, along with a good communication between the neurophysiologist and the surgical team , can reduce the morbidity of these procedures to a minimum.