Intraoperative Neurophysiological Monitoring in Anterior Lumbar Interbody Fusion Surgery

Purpose: Somatosensory evoked potential (SSEP) and motor evoked potentials (MEP) are frequently fused to monitor neurological function during spinal deformity surgery. However, there are few studies regarding the utilization of intraoperative neuromonitoring during anterior lumbar interbody fusion (ALIF). This study presents the authors' experience with intraoperative neuromonitoring in ALIF. Methods: A retrospective review of all patients undergoing ALIF with intraoperative neuromonitoring from November 2008 to July 2013 was performed. Factors including gender, operative time, blood loss, and number and levels of interbody fusions were analyzed as risk factors for interoperational alerts. Results: A total of 189 consecutive patients who underwent ALIFs were studied. All 189 patients had SSEP, and 131 patients had MEP as part of the intraoperative neuromonitoring in addition. The remaining 58 patients did not have MEP due to neuromuscular blockade requested by the exposure surgeon. There were no isolated intraoperative MEP changes. A total of 15 (7.9%) patients experienced intraoperative alerts. Thirteen (6.8%) of them were in SSEP. Two (1.1%) had MEP and SSEP changes together. None of these patients had new neurologic deficits postoperatively because of the surgeon's responses to the intraoperative alert. Increased risk of SSEP changes was seen in patients undergoing fusion of both L4/5 and L5/S1 (P=0.024) and longer surgical duration (P=0.036). No correlation was found between age and positive SSEP changes (P>0.05). Conclusions: Somatosensory evoked potential changes occur relatively, frequently, and intraoperatively during ALIF. No patients with positive intraoperative SSEP changes demonstrated new postoperational deficits. Concurrent fusion of both the L4/5 and L5/S1 levels was significant risk factors for SSEP changes leading to intraoperative alerts. Operative duration and increased blood loss during surgery trended toward but did not reach statistical significance.