Femoral nerve neuromonitoring for lateral lumbar interbody fusion surgery.

Background Context: The transpsoas lateral lumbar interbody fusion (LLIF) technique is an effective alternative to traditional anterior and posterior approaches to the lumbar spine; however, nerve injuries are the most reported postoperative complication. Commonly used strategies to avoid nerve injury (eg, limiting retraction duration) have not been effective in detecting or preventing femoral nerve injuries.

Purpose: To evaluate the efficacy of emerging intraoperative femoral nerve monitoring techniques and the importance of employing prompt surgical countermeasures when degraded femoral nerve function is detected.

Causal factors for position-related SSEP changes in spinal surgery.

Background Context: Somatosensory evoked potentials (SSEPs) are effective in detecting upper extremity positional injuries; however, causal factors for which patient population is most at risk are not well established.

Purpose: To review causal factors for intraoperative SSEP changes due to patient positioning.

Study Design: A case series with retrospective chart analysis was performed.

Motor evoked potentials for femoral nerve protection in transpsoas lateral access surgery of the spine.

Detecting potential intraoperative injuries to the femoral nerve should be the main goal of neuromonitoring of lateral lumber interbody fusion (LLIF) procedures. We propose a theory and technique to utilize motor evoked potentials (MEPs) to protect the femoral nerve (a peripheral nerve), which is at risk in LLIF procedures. MEPs have been advocated and widely used for monitoring spinal cord function during surgical correction of spinal deformity and surgery of the cervical and thoracic spine, but have had limited acceptance for use in lumbar procedures.

Utilization of paraspinal muscles for triggered EMG during thoracic pedicle screw placement.

A novel intraoperative neurophysiological technique for testing the integrity of the pedicle during screw fixation for spinal deformity surgery is presented. The thoracic paraspinal muscles at the appropriate level are used as the electromyogram (EMG) pick-up for direct current stimulation of the thoracic pedicle screw at that level. This technique is shown to give reliable and reproducible results.