Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: Electrophysiological monitoring and lumbar fusion: Electrophysiological monitoring and lumbar fusion

Alok Sharan, Michael W. Groff, Andrew T. Dailey, Zoher Ghogawala, Zoher Ghogawala, Daniel K. Resnick, William C. Watters, Praveen V. Mummaneni, Tanvir F. Choudhri, Jason C. Eck, Jeffrey C. Wang, Sanjay S. Dhall, Michael G. Kaiser

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

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.
Original languageEnglish (US)
Pages (from-to)102-105
Number of pages4
JournalJournal of Neurosurgery: Spine
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • Fusion
  • Intraoperative monitoring
  • Lumbar spine
  • Practice guidelines

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