Influence of rigid spinal instrumentation on the neurogenic motor evoked potential

Three case reports are presented to illustrate how placement of spinal instrumentation obliterates previously normal neurogenic motor evoked potentials (NMEPs) elicited by transosseous electrical stimulation. This results in an unacceptably high false-positive rate for NMEP recordings during scoliosis surgery. The loss of the NMEPs was attributed to shunting of electrical current from JO5 spinous process stimulating needles through the metal rod to ground, thus preventing adequate stimulation to the spinal cord. A modification of the transosseous technique with epidural stimulation to improve test reliability is described.