title: Intraoperative neurophysiological monitoring for minimally invasive 1- and 2-level transforaminal lumbar interbody fusion: does it improve patient outcome?
abstract: BACKGROUND
  Despite the widespread use of intraoperative monitoring (IOM) in many types of spinal surgeries, an absence of data comparing monitored a nd unmonitored postoperative outcomes places IOM's efficacy into question. A lack of consensus among surgeons about when to use monitoring also raises concerns about its overuse in routine and low-risk procedures.
  
  
  METHODS
  We performed a retrospective database review of 112 patients undergoing a 1- or 2-level minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF). Our analysis focused on patient demographics, use of IOM, length of surgery, hospital length of stay, the perioperative complication of pedicle screw malposition, and average hospital cost.
  
  
  RESULTS
  For the 73 patients who underwent MIS-TLIF with intraoperative neuromonitoring, their hospital length of stay (P=0.8) and need for pedicle screw revisions (P=0.93) were not statistically significant compared to the 39 patients who underwent MIS-TLIF procedures without IOM. The incidence of reoperation was 5.48% and 5.13%, and average length of stay was 3.25 days and 3.13 days, respectively. However, the cost of surgery and the length of surgery were significantly higher in the monitored group compared to the nonmonitored group (P=0.008 and P=0.009, respectively).
  
  
  CONCLUSIONS
  IOM is widely used in spine surgery, but our retrospective review shows that its use does not necessarily decrease the incidence of malpositioning of pedicle screws. In fact, no statistical difference was detected in the incidence of screw malposition in the 2 groups of patients. On the other hand, IOM adds cost and increases the length of surgery. Because the use of IOM did not make a difference in the incidence of pedicle screw malpositioning and because of the comparative cost analysis for both groups of patients, we believe that the use of IOM for MIS-TLIF provides no added benefit.
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA ; Department of Neurosurgery, Tulane Medical Center, New Orleans, LA.
authors.forename: Juanita
authors.initials: J
authors.lastname: Garces
authors.affiliation: Department of Neurosurgery, Tulane Medical Center, New Orleans, LA.
authors.forename: J Franklin
authors.initials: JF
authors.lastname: Berry
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA ; Department of Neurosurgery, Tulane Medical Center, New Orleans, LA.
authors.forename: Edison P
authors.initials: EP
authors.lastname: Valle-Giler
authors.affiliation: Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Wale A R
authors.initials: WA
authors.lastname: Sulaiman
keywords: Monitoring–intraoperative; spinal fusion; surgical procedures–minimally invasive