Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: electrophysiological monitoring and lumbar fusion

Resnick, Daniel K.; Choudhri, Tanvir F.; Dailey, Andrew T.; Groff, Michael W.; Khoo, Larry T.; Matz, Paul G.; Mummaneni, Praveen V.; Watters, William C.; Wang, Jeffrey; Walters, Beverly C.; Hadley, Mark N.

doi:10.3171/spi.2005.2.6.0725

Cited by 41 publications

(23 citation statements)

References 44 publications

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“…In addition, the current study included a robust statistical analysis to adjust for baseline risk stratification. Although the clinical management of individual patients was performed according to the judgment of individual board certified surgeons, patient selection adhered to published guidelines for lumbar fusion (22)(23)(24)(25)(26).…”

Section: Discussionmentioning

confidence: 99%

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A Prospective, Multi-Institutional Comparative Effectiveness Study of Lumbar Spine Surgery in Morbidly Obese Patients: Does Minimally Invasive Transforaminal Lumbar Interbody Fusion Result in Superior Outcomes?

et al. 2015

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Section: Discussionmentioning

confidence: 99%

“…The overall mean AE SD age was 56 25. AE 10.91 years (MIS-TLIF: 56.62 AE 11.69 years vs. open-TLIF: 56.12 AE 10.68 years, P ¼ 0.82), of which 67 were men and 81 were women, Table 1.…”

mentioning

confidence: 98%

A Prospective, Multi-Institutional Comparative Effectiveness Study of Lumbar Spine Surgery in Morbidly Obese Patients: Does Minimally Invasive Transforaminal Lumbar Interbody Fusion Result in Superior Outcomes?

et al. 2015

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“…14 Proponents of EMG claim that it provides useful clinical information regarding the status of the pedicle wall. 12,18,19 However, opponents cite evidence of false-negative rates (i.e. post-operative neurologic injury despite normal EMG readings), suggesting that intraoperative EMG does not help surgeons avoid neurologic injury.…”

Section: Discussionmentioning

confidence: 99%

Utility of Intraoperative Neuromonitoring for Lumbar Pedicle Screw Placement Is Questionable

Ajiboye

Zoller

D’Oro

et al. 2017

Spine

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STRUCTURED ABSTRACT Study Design 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. Summary of Background Data 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 that 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, 2007–2015, 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.

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“…Both the American Academy of Neurosurgeons and the American Society of Neuromonitoring list EMG as the most useful root monitoring technique. 9,10 However, recent studies questioned the reliability of free-run EMG in preventing nerve root palsy, noting the high incidence of false-positives and very low positive-predictive value. [11][12][13] Direct electrical stimulation of nerve roots to evoke an EMG response has promise, 10,14 but may be difficult to perform during active retraction.…”

mentioning

confidence: 98%

Relative Efficacy of Transcranial Motor Evoked Potentials, Mechanically-Elicited Electromyography, and Evoked EMG to Assess Nerve Root Function During Sustained Retraction in a Porcine Model

Lyon¹,

Lieberman²,

Feiner³

et al. 2009

Spine

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Three electrophysiologic methods were used intraoperatively to assess neural function during retraction of a single nerve root. Retraction produced consistent changes in TcMEPs and evoked EMG. These 2 methods show promise for assessing the limits on the force and duration of nerve root retraction during spine surgery. Mechanically elicited EMG was not sensitive to the amount and duration of nerve root retraction.

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Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: electrophysiological monitoring and lumbar fusion

Cited by 41 publications

References 44 publications

A Prospective, Multi-Institutional Comparative Effectiveness Study of Lumbar Spine Surgery in Morbidly Obese Patients: Does Minimally Invasive Transforaminal Lumbar Interbody Fusion Result in Superior Outcomes?

A Prospective, Multi-Institutional Comparative Effectiveness Study of Lumbar Spine Surgery in Morbidly Obese Patients: Does Minimally Invasive Transforaminal Lumbar Interbody Fusion Result in Superior Outcomes?

Utility of Intraoperative Neuromonitoring for Lumbar Pedicle Screw Placement Is Questionable

Relative Efficacy of Transcranial Motor Evoked Potentials, Mechanically-Elicited Electromyography, and Evoked EMG to Assess Nerve Root Function During Sustained Retraction in a Porcine Model

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