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IONM During Lumbosacral Spinal Fusion Procedures

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Koht, Sloan, Toleikis's Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

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Abstract

During lumbosacral spinal fusion procedures, the overarching goal is to mitigate the risk of new or worsened neurologic deficits secondary to iatrogenic nerve root or lumbosacral plexus injury. One objective is to avoid direct mechanical irritation or insult to neural elements using spontaneous and triggered electromyography (EMG) to detect proximity of surgical instruments and implants. While an 8-mA threshold for pedicle screw testing remains the most prudent alert criterion, it should be adjusted based on patient factors such as bone porosity. A second objective is to alert the surgeon to possible evolving dysfunction. EMG and somatosensory-evoked potentials (SSEPs) have historically shown relatively weak sensitivity in diagnosing spinal nerve root dysfunction during surgery, while motor-evoked potentials (MEPs) have demonstrated excellent accuracy when appropriate alert criteria and optimized anesthetic regimens are utilized. IONM professionals should be aware of the strengths and limitations of each test modality, and, based on diagnosis, procedure, and patient factors, advocate for a multimodality approach to maximize diagnostic accuracy and potential therapeutic impact of IONM.

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Authors and Affiliations

  1. SpecialtyCare, Brentwood, TN, USA

    W. Bryan Wilent, Julie Trott, Thomas Epplin-Zapf & Anthony K. Sestokas

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  1. W. Bryan Wilent
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  2. Julie Trott
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  4. Anthony K. Sestokas
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Correspondence to W. Bryan Wilent .

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Editors and Affiliations

  1. Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA

    Christoph N. Seubert

  2. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Jeffrey R. Balzer

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Wilent, W.B., Trott, J., Epplin-Zapf, T., Sestokas, A.K. (2023). IONM During Lumbosacral Spinal Fusion Procedures. In: Seubert, C.N., Balzer, J.R. (eds) Koht, Sloan, Toleikis's Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals. Springer, Cham. https://doi.org/10.1007/978-3-031-09719-5_33

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  • DOI: https://doi.org/10.1007/978-3-031-09719-5_33

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