Neurophysiologic Monitoring for Spondylolisthesis Surgery

Rationale for Determination

The American Association of Neurological Surgeons recommends decompression with fusion for symptomatic spondylolisthesis, but does not indicate routine neurophysiologic monitoring 1, 2
Surgical decompression with fusion is the recommended treatment for symptomatic spondylolisthesis with radiculopathy after failure of conservative management, as supported by the SPORT studies 1, 2
Decompression with fusion is superior to decompression alone for spondylolisthesis, as recommended by the American Association of Neurological Surgeons 1

The SPORT studies provide strong evidence supporting surgical intervention for spondylolisthesis with stenosis, demonstrating superior outcomes compared to non-operative management 2
Guidelines from the American Association of Neurological Surgeons recommend decompression with fusion for symptomatic spondylolisthesis but do not indicate routine neurophysiologic monitoring 2, 1

There is no evidence in the clinical guidelines supporting routine use of intraoperative neurophysiologic monitoring for standard TLIF procedures for spondylolisthesis 3, 2
Additional neurophysiologic testing is not indicated when the diagnosis is already established and correlates with clinical findings 3, 2

MRI is the initial imaging modality of choice for patients with radiculopathy who have failed conservative therapy 1
The MCG criteria for electromyography and nerve conduction studies specify that these tests are indicated for radiculopathy only when there is suspected nerve root impingement based on clinical grounds or imaging studies 1