Why monitor SSEPs for lumbar surgery?

[propadex]

We don't perform MEPs for lumbar surgeries below L1 so why do we perform SSEPs for these cases?

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[chocomorsel]

Money? It seems to be the answer to everything in America. IDK. Once I got out of places where the surgeons didn't own a share of the Neuromonitoring companies and residency, neuromonitoring simply wasn't done.

 

[anbuitachi]

We don't perform MEPs for lumbar surgeries below L1 so why do we perform SSEPs for these cases?

why dont you perform MEP for lumbar surgeries below L1?

 

[DirtDocMD]

Money? It seems to be the answer to everything in America. IDK. Once I got out of places where the surgeons didn't own a share of the Neuromonitoring companies and residency, neuromonitoring simply wasn't done.

Yep. I think you’re on to something....

 

[caligas]

CYA?

 

[deleted875186]

I asked one of the neurosurgeons straight up how they choose to do neuromonitoring and for what cases, no straightforward answer.

 

[GassYous]

All I know is that the time it takes to place those needles is cash in my pocket.

 

[deleted162650]

why dont you perform MEP for lumbar surgeries below L1?

MEPs aren’t helpful if you’re below the cord.

 

[1984]

MEPs are monitoring the integrity of the spinal cord which terminates at around L1. SSEPs are looking more at the specific nerve roots which can be affected by lumbar hardware placement (eg, pedicle screw). I haven't seen too much monitoring in the lumbar region when hardware is not being placed, but I do agree that the answer to everything is $$$. It is my understanding, neuromonitoring hasn't been shown to affect outcomes except for major spine deformity surgery.

 

[deleted162650]

so why do we perform SSEPs for these cases?

Because you can’t use MEPs below the cord.

 

[dhb]

Money? It seems to be the answer to everything in America. IDK. Once I got out of places where the surgeons didn't own a share of the Neuromonitoring companies and residency, neuromonitoring simply wasn't done.

I don't think i've ever seen it done hereprobably because there is no billing code for it. So yeah it's got to be the $

 

[anbuitachi]

MEPs aren’t helpful if you’re below the cord.

MEPs are monitoring the integrity of the spinal cord which terminates at around L1. SSEPs are looking more at the specific nerve roots which can be affected by lumbar hardware placement (eg, pedicle screw). I haven't seen too much monitoring in the lumbar region when hardware is not being placed, but I do agree that the answer to everything is $$$. It is my understanding, neuromonitoring hasn't been shown to affect outcomes except for major spine deformity surgery.

Because you can’t use MEPs below the cord.

MEPs are best for cord ischemia, but it still requires intact motor pathway (from motor cortex all the way down to muscle) for it to function doesnt it? if surgeon jams entire screw into cauda equina or lumbar nerve roots, wouldnt you see MEP changes?

Dont studies show MEP + SSEP is more sensitive?

 

[dannyboy1]

I don't think i've ever seen it done hereprobably because there is no billing code for it. So yeah it's got to be the $

They don’t get to choose between an LMA or ETT and I don’t weigh in on neurosurgical decision making. Things work better this way.

 

[DirtDocMD]

As a surgeon once told (joked) to me, “I never fo unnecessary procedures. I ALWAYS need the money....”