Utility of Intraoperative Neuromonitoring for Lumbar Pedicle Screw Placement Is Questionable: A Review of 9957 Cases

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