Accuracy of t-EMG stimulation of the middle pedicle track to prevent radiculopathies as a result of misplaced lumbar screws
| Autor: | Eduardo Hevia, Luis M. Antón-Rodrigálvarez, Gonzalo Mariscal, L. Cabañes, Carlos Barrios, Jesús Burgos |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male musculoskeletal diseases medicine.medical_specialty Adolescent Pain Palpation Young Adult 03 medical and health sciences 0302 clinical medicine Lumbar Pedicle Screws Monitoring Intraoperative medicine Foramen Humans Child Radiculopathy Pedicle screw Device Removal Medical Errors medicine.diagnostic_test Electromyography business.industry Track (disk drive) Lumbosacral Region General Medicine equipment and supplies musculoskeletal system medicine.disease Electric Stimulation Spine Surgery surgical procedures operative Radicular pain Fluoroscopy 030220 oncology & carcinogenesis Female Neurology (clinical) Tomography X-Ray Computed Radiculopathies business 030217 neurology & neurosurgery Intraoperative neurophysiological monitoring |
| Zdroj: | Clinical Neurology and Neurosurgery. 195:105915 |
| ISSN: | 0303-8467 |
| DOI: | 10.1016/j.clineuro.2020.105915 |
| Popis: | To describe the accuracy of middle pedicle track stimulation for the detection of pedicle breaches causing misplaced lumbar screws and subsequent neurological symptoms.In a comparative observational study with two cohorts, 1440 lumbar pedicle screws were implanted using the freehand technique in 242 patients undergoing surgery for spinal deformities. In the first two-year period (2011-2012), the accuracy of screw placement (802 screws) was assessed by conventional intraoperative palpation of the pedicle track, t-EMG screw stimulation, and fluoroscopic monitoring. In the second period (2012-2013), the middle aspect of the lumbar pedicle tracks was systematically stimulated with a probe (638 screws). When thresholds in the middle track showed9 mA, potential neurological risk was considered, and therefore, new pedicle tracks were performed.Six patients (4.4 %) in the first period presented postoperative radicular pain and a normal intraoperative screw t-EMG threshold. CT scans showed seven screws (0.9 %) with2-mm medial-caudal invasion of the foramen. Before screw removal, t-EMG thresholds of these screws were again normal (≥10 mA). After removal of the screws. t-EMG of the middle part of the pedicle track showed thresholds below 9 mA (mean 5.2 mA). In the second period, the pedicle tracks were systematically stimulated. Low t-EMG thresholds (9 mA) were found in 11 tracks (1.7 %) and were therefore reworked before screw placement. CT scans in these 10 patients showed that all of the 11 screws were correctly repositioned.This study shows that caudal or medial pedicle cortical breaches can be detected effectively by stimulating the middle part of the pedicle track. This technique is strongly recommended to prevent postoperative lumbar radiculopathies due to screw malposition. |
| Databáze: | OpenAIRE |
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