title: Utility of Intraoperative Neuromonitoring for Lumbar Pedicle Screw Placement Is Questionable: A Review of 9957 Cases.
abstract: METHODS
  A retrospective database study.
  
  
  OBJECTIVE
  The goal of this study was to (1) evaluate the trends in the use of electromyography (EMG) for instrumented posterolateral lumbar fusions (PLFs) in the United States and (2) assess the risk of neurological injury following PLFs with and without EMG.
  
  
  BACKGROUND
  Neurologic injuries from iatrogenic pedicle wall breaches during screw placement are known complications of PLFs. The routine use of intraoperative neuromonitoring (ION) such as EMG during PLF to improve the accuracy and safety of pedicle screw implantation remains controversial.
  
  
  METHODS
  A retrospective review was performed using the PearlDiver Database to identify patients who had PLF surgery with and without EMG for lumbar disorders from years 2007 to 2015. Patients undergoing concomitant interbody fusions or spinal deformity surgery were excluded. Demographic trends and risk of neurological injuries were assessed.
  
  
  RESULTS
  During the study period, 2007 to 2015, 9957 patients underwent PLFs. Overall, EMG was used in 2495 (25.1%) of these patients. There was a steady increase in the use of EMG from 14.9% in 2007 to 28.7% in 2009, followed by a steady decrease to 21.9% in 2015 (P < 0.0001). The risk of postoperative neurological injuries following PLFs was 1.35% (134/9957) with a risk of 1.36% (34/2495) with EMG and 1.34% (100/7462) without EMG (P = 0.932). EMG is used most commonly for PLFs in the Southern part of the United States.
  
  
  CONCLUSIONS
  In this retrospective national database review, we found that there was a steady increase in the routine use of EMG for PLFs followed by a steady decline. Regional differences were observed in the utility of EMG for PLFs. The risk of neurological complications following PLF in the absence of spinal deformity is low and the routine use of EMG for PLF may not decrease the risk.
  
  
  METHODS
  4.
authors.affiliation: UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: Remi M
authors.initials: RM
authors.lastname: Ajiboye
authors.affiliation: UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Zoller
authors.affiliation: Keck Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: Anthony
authors.initials: A
authors.lastname: D'Oro
authors.affiliation: UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: Zachary D
authors.initials: ZD
authors.lastname: Burke
authors.affiliation: UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: William
authors.initials: W
authors.lastname: Sheppard
authors.affiliation: Keck Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wang
authors.affiliation: Keck Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: Zorica
authors.initials: Z
authors.lastname: Buser
authors.affiliation: Keck Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Wang
authors.affiliation: UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA.
authors.forename: Sina
authors.initials: S
authors.lastname: Pourtaheri
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual / Q000639:trends; D004576:Electromyography / Q000379:methods / Q000639:trends; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods* / Q000639:trends; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods* / Q000639:trends