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

Standards. There is insufficient evidence to recommend a treatment standard. Guidelines. Use of intraoperative SSEP or DSEP monitoring is recommended as an adjunct in those circumstances during instrumented lumbar spinal fusion procedures in which the surgeon desires immediate intraoperative information regarding the potential of a neurological injury. The occurrence of a postoperative neurological deficit is highly correlated with intraoperative changes in these monitoring modalities. An abnormal SSEP or DSEP during surgery, however, often does not correlate with a postoperative neurological injury because of a high false-positive rate. Use of intraoperative evoked EMG recordings is recommended in those circumstances in which the operating surgeon wishes to confirm the lack of a neurological injury during pedicle screw placement. A normal evoked EMG response is highly predictive of the lack of a neurological injury. An abnormal EMG response during the surgical procedure may or may not be associated with a clinically significant injury. Options. Intraoperative evoked EMG recording is recommended as an option during lumbar spinal fusion surgery in those situations in which the operating surgeon desires immediate information regarding the integrity of the pedicle wall, as a normal evoked EMG response is correlated with an intact pedicle wall.