Ofcourse if you have electophysiology and connected properly, then no need for wakeup test.But some centrs and surgeons still use wake up ..and we did many cases with it.

In case of deviations in the electrophysiological monitoring, we perform the wake-up test as a last control method because some pseudonegative or pseudopositive deviations are possible. So the wake-up test is a good control tool. I also think it has not lost its significance

I believe that if you have good monitoring and interpretation then there is no need to perform a wake-up test. The monitoring must be reliable, and a strong relationship developed between all members of the team

@Dr. Norton. You are right. But if the monitoring shows some signal deviations, do you perform immediately loosening or extraction of the implants ? Or perhaps try the wake-up test to confirm the neurologic damage and then proceed with the correction of instrumentation ?

Thank you, Joseph. I agree entirely with you. It is a very strange trend in the practice of medicine to throw out some successful old methods in favor of sophisticated and expensive new ones.This is the reason for gradually making health care more and more expensive and cost-ineffective. I do not stand against the evolution/revolution in the practice of medicine, but I am sure that well experienced methods should be preserved where they still work.

I agree too,if you have electophysiology and connected properly, then no need for wakeup test,but this test should be preserved for same cases.

Dr. Bacciarini, I agree with you with your opinion. Thank you.

the wake up test is outmoded and dangerous and should be largely abandoned. If you have reliable established neuromonitoring and there is an abrupt and persistent change in all modalities, it should be acted on immediately. often it takes almost an hour to wake the patient enough to carry out a valid test; time wasted if there is a reversible neurologic problem. There is the risk of self extubation in the prone position,and increased bleeding due to the increase in BP. And the test cannot be performed on patients with inability to comply with commands, who arer often the patients who have the most risk.I advise removing rods, leaving anchors, closing, evaluating in the recovery room, MRI or CAT scan eval, and reinstrumenting at a later date

Dr. King, I do not agree that the wake up test takes an hour to perform it properly. The  modern anesthestics allow rapid waking of the patient. It takes just a couple of minutes. Experienced anesthesiologist and a good cooperation with the surgeon is also needed.

Meanwhile, I have a question. In case of electrophysiologic signs of spinal cord function disturbance, do you immediately remove the rods without waking the patient to verify clinically the neurologic status ? Or before taking the  patient to the recovery room you just make him "wiggle the toes". It is well known that pseudonegative or pseudopositive signs are possible with any sophisticated diagnostic technical device. 

If there is a major change in what was a reliable and clear monitoring signal, and especially if it occurred soon after a maneuver that could cause spinal chord problems, we immediately take measures. First, raise the blood pressure, check monitoring leads, raise core temperature etc. When I do a wake up test, we wake the patient to the point where they will squeeze a hand on command. only once that is established will we ask them to move the toes.Of course, too often, surgeons will take withdrawal of a foot or leg in response to stimulus as a sign of intact neurologic function. Curiously, in cases where there has been a neurologic deficit the patient seems to take a long time to wake up.The anesthesiologist will tell you the patient is breathing pure air and will wake up shortly, but they dont. I was always cautious in continuing a procedure where there has been significant monitoring changes, but a negative wake up test, so I do not do the wake up test. We are fortunate to have a very experienced monitoring team (we do SSEPs, TCMEPs, Hreflexes, and threshold EMGs).Very seldom do we have a false positive. If I remove the instrumentation and the patient is normal in the recovery room, that is not a false positive.We then decide if we need further imaging or tests.We usually come back within days, and reinstrument with less correction. ( I will often change out fixed or uniaxial screws for multiaxials, that put less strain on the spine.The most difficult decisions are monitopring changes after the spine hasbeen destabilized by an osteotomy or vertebrectomy. There you cannot remove stabilising innstrumentation, so extending a decompression is needed, or removal of a concave pedicle,

Of course, all this is anecdotal.Studies are difficult due to rarity of the denominator , and the variability of the conditions being treated, monitoring used , and surgeons decision making