Abstract
Pedicle screw (PS) instrumentation is widely used for correcting spinal deformity and instability. However, insertion of PS is always exposed to the risk of nerve root injury. For safe placement of PS, multiple methods such as visualization, palpation and imaging technique have been applied, but all of them have some limitations. Intraoperative neurophysiological monitoring (INM), specifically triggered electromyography (t-EMG) is a useful test for securing safety during spinal instrumentation. It is a quick and accurate method based on neurophysiological changes due to neural injury, but there is also a problem that the reliability of this test is doubtful because of low sensitivity and variable stimulation thresholds. This review focuses on not only methodology and pitfalls of INM for spinal root and PS evaluation, but advantages and limitations of INM compared with other diagnostic methods. Further, we suggest the need for a new protocol ensuring maximum safety through combination of INM and other techniques.
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