The present invention involves systems (20) and related methods for performing percutaneous pedicle integrity assessments involving the use of neurophysiology. The fundamental method steps for performing the percutaneous pedicle integrity assessments include (a) percutaneously introducing an insulation member to a pedicle target site; (b) establishing electrical communication between a stimulation element and an interior of a pedicle screw pilot hole; (c) applying a stimulation signal to the stimulation element; and (d) monitoring to assess whether nerves adjacent the pedicle are innervating as a result of the step of applying the stimulation signal to the stimulation element.