title: Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: electrophysiological monitoring and lumbar fusion.
abstract: Intraoperative monitoring (IOM) is commonly used during lumbar fusion surgery for the prevention of nerve root injury. Justification for its use stems from the belief that IOM can prevent nerve root injury during the placement of pedicle screws. A thorough literature review was conducted to determine if the use of IOM could prevent nerve root injury during the placement of instrumentation in lumbar or lumbosacral fusion. There is no evidence to date that IOM can prevent injury to the nerve roots. There is limited evidence that a threshold below 5 mA from direct stimulation of the screw can indicate a medial pedicle breach by the screw. Unfortunately, once a nerve root injury has taken place, changing the direction of the screw does not alter the outcome. The recommendations formulated in the original guideline effort are neither supported nor refuted with the evidence obtained with the current studies.
authors: Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;
authors: Alok
authors: A
authors: Sharan
authors: Michael W
authors: MW
authors: Groff
authors: Andrew T
authors: AT
authors: Dailey
authors: Zoher
authors: Z
authors: Ghogawala
authors: Daniel K
authors: DK
authors: Resnick
authors: William C
authors: WC
authors: Watters
authors: Praveen V
authors: PV
authors: Mummaneni
authors: Tanvir F
authors: TF
authors: Choudhri
authors: Jason C
authors: JC
authors: Eck
authors: Jeffrey C
authors: JC
authors: Wang
authors: Sanjay S
authors: SS
authors: Dhall
authors: Michael G
authors: MG
authors: Kaiser
mesh_terms: D001863:Bone Screws; D004576:Electromyography; D019317:Evidence-Based Medicine; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000592:standards*; D017410:Practice Guidelines as Topic; D013122:Spinal Diseases / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000592:standards*; D013126:Spinal Nerve Roots / Q000293:injuries*
keywords: EMG = electromyography; IOM = intraoperative monitoring; MEP = motor evoked potential; SSEP = somatosensory evoked potential; fusion; intraoperative monitoring; lumbar spine; practice guidelines