Correlation of late intraforaminal screw removal with somatosensory evoked potentials and neurologic improvement

This case report describes the intraoperative improvement of somatosensory evoked potentials (SEPs) during the removal of a broached pedicle screw that had been placed in an unmonitored procedure 1 month earlier. Postoperatively, there was improved neurologic function and reversal of the neurologic deficit that had been caused by the first procedure. To our knowledge, this is the first report of a correlation of intraoperative SEP improvement with improved postoperative neurologic function after neurologic deficit because of nerve irritation or compression from a pedicle screw. Nerve damage occurs in about 15% of patients who undergo instrumentation after lumbar fusion. The potential utility of neurophysiologic methods during initial screw placement is suggested and supported, as proper use of such intraoperative tools may have prevented the need for the second procedure.