Focus of Report: This report focuses on intraoperative neuromonitoring (IONM) for the detection and prevention of surgical manipulations that could cause nerve damage during lumbar spinal discectomy alone or discectomy plus fusion.

Technology Description: During discectomy or fusion of the lumbar spine, the most common IONM techniques used are electromyography (EMG), somatosensory evoked potential (SSEP), and motor evoked potential (MEP), which may be used alone or in combinations. To monitor the nerves that could be affected during lumbar spinal surgery, electrodes and/or other monitoring devices are placed at the appropriate spinal sites and other sites on the body, and are used to monitor spontaneous and stimulated nerve and muscle activity.

Controversy: Setting up and performing IONM prolongs surgery, and this technique may provide limited or no benefit for most patients, particularly those who are undergoing relatively simple spinal procedures such as partial discectomy or fusion of only 1 or 2 spinal levels.

Key Questions:

  • Is IONM an accurate method for detecting surgical manipulations that could cause nerve damage during lumbar discectomy or fusion?

  • During lumbar discectomy or fusion, does IONM enable avoidance of nerve damage?

  • How does IONM compare with other methods of intraoperative guidance or monitoring during lumbar discectomy or fusion?

  • Is IONM associated with any safety issues in patients who are undergoing lumbar discectomy or fusion?

  • Have definitive patient selection criteria been established for IONM for lumbar discectomy or fusion?

If you have a Hayes login, click here to view the full report on the Knowledge Center.