Point-Counterpoint: The Use of Neuromonitoring in Lateral Transpsoas Surgery

Spine
Ivan ChengMartin Pham

Abstract

Expert opinion. The objective of this study is to debate the requirement for intraoperative neuromonitoring in 90° lateral transpsoas spine surgery (lateral lumbar interbody fusion [LLIF]) in a point-counterpoint style with an argument made for each side followed by a brief rebuttal of each. Dr. Ivan Cheng will argue in favor of the use of neuromonitoring in LLIF, and Dr. Frank Acosta will argue against the requirement for the use of neuromonitoring in LLIF. The lateral approach to the lumbar spine has been used since at least the 1990s and requires passage near or adjacent to the lumbar plexus. The mini-open lateral transpsoas approach was introduced in the literature in 2006 and uses evoked electromyography integrated into the approach and procedural instrumentation that stimulates in directional orientations and provides discrete threshold responses to avoid the nerves of the lumbar plexus. More recently, lateral transpsoas approaches to the lumbar spine have been developed that do not require or advocate for the use of neuromonitoring, instead relying on direct visualization and avoidance of nerves (shallow-docking). Two experienced lateral approach surgeons who regularly perform lateral transpsoas approaches with integrate...Continue Reading

Citations

Oct 28, 2020·Asian Spine Journal·Jiwon ParkJin S Yeom

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