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Journal of Long-Term Effects of Medical Implants

Published 4 issues per year

ISSN Print: 1050-6934

ISSN Online: 1940-4379

SJR: 0.184 SNIP: 0.485 CiteScore™:: 1.1 H-Index: 39

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Accuracy of Pedicle Screw Placement Using Intraoperative Neurophysiological Monitoring and Computed Tomography

Volume 19, Issue 1, 2009, pp. 41-48
DOI: 10.1615/JLongTermEffMedImplants.v19.i1.50
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ABSTRACT

Fifty consecutive patients with posterior thoracolumbar spine fusion were included in a prospective study to determine the accuracy of intraoperative neurophysiological monitoring (IONM) for safe pedicle screw placement using postoperative computed tomography (CT). The patients were allocated into two equal groups. Pedicle screw placement was evaluated intraoperatively by using the image intensifier. In group A, the integrity of the pedicle wall was evaluated intraoperatively with monopolar stimulation of each screw head with a hand-held single-tip stimulator; the compound muscle action potentials were recorded. A constant current threshold of 7 mA was considered indicative of pedicle breach; < 7 mA was considered as direct contact with neural elements, and > 7mA was considered normal. In group B, pedicle screw placement was performed without IONM. Overall, 306 pedicle screws were inserted in both groups. Postoperatively, all patients underwent CT scans of the spine to evaluate pedicle screw placement. Intraoperatively, five screws in respective group A patients had to be repositioned after IONM (threshold of < 7 mA); in these patients, postoperative CT scans showed proper screw placement. Postoperative CT scans showed eight misdirected screws; two screws (1.26%) in group A patients and six screws (4%) in group B patients. Two screws were misdirected through the medial pedicle wall and six screws were misdirected through the lateral pedicle wall. Both medially misdirected screws were observed in group B patients (1.35%); these patients developed neurologic symptoms postoperatively and underwent revision surgery, with redirection of the misdirected screws and subsequent resolution of the neurologic symptoms. Two of the six laterally misdirected screws were observed in group A patients (1.26%); the remaining four laterally misdirected screws were observed in group B patients (2.7%). None of these patients had neurologic sequelae; no revision surgery was required. The cut-off value of 7 mA had a 98.73% (> 95%) positive predictive value for accurate pedicle screw placement.

CITED BY
  1. Jenkins Tyler J., Kannan Abhishek S., Hsu Wellington K., Neuromonitoring for cervical disc surgery: Concepts and controversies, Seminars in Spine Surgery, 28, 2, 2016. Crossref

  2. Azabou E., Delage J.-M., Hennig M., Macadoux G., Lofaso F., Garreau de Loubresse C., Monitorage non invasif et sélectif des cordons postérieurs et de la voie pyramidale pendant les chirurgies du rachis et de la moelle épinière, Revue Neurologique, 171, 8-9, 2015. Crossref

  3. Berlin Connor D., Seshan Thirumoorthi V., Abrahams John M., Kornel Ezriel E., Intraoperative herniation of an L5-S1 disc during microdiscectomy and transforaminal lumbar interbody fusion: a case report, Journal of Medical Case Reports, 9, 1, 2015. Crossref

  4. Kassis Sebouh Z., Abukwedar Loay K., Msaddi Abdul Karim, Majer Catalin N., Othman Walid, Combining pedicle screw stimulation with spinal navigation, a protocol to maximize the safety of neural elements and minimize radiation exposure in thoracolumbar spine instrumentation, European Spine Journal, 25, 6, 2016. Crossref

  5. Lund Teija, Laine Timo, Österman Heikki, Yrjönen Timo, Schlenzka Dietrich, Computer-Aided Spine Surgery, in European Surgical Orthopaedics and Traumatology, 2014. Crossref

  6. Hubbe Ulrich, Sircar Ronen, Scheiwe Christian, Scholz Christoph, Kogias Evangelos, Krüger Marie Therese, Volz Florian, Klingler Jan-Helge, Surgeon, staff, and patient radiation exposure in minimally invasive transforaminal lumbar interbody fusion: impact of 3D fluoroscopy-based navigation partially replacing conventional fluoroscopy: study protocol for a randomized controlled trial, Trials, 16, 1, 2015. Crossref

  7. Shao Xiexiang, Huang Zifang, Yang Jingfan, Deng Yaolong, Yang Junlin, Sui Wenyuan, Efficacy and safety for combination of t-EMG with O-arm assisted pedicle screw placement in neurofibromatosis type I scoliosis surgery, Journal of Orthopaedic Surgery and Research, 16, 1, 2021. Crossref

  8. Beaulieu Lalanne L., Larrondo Carmona R., Alvarez Lemos F., Oelker Behn C., Cáceres Copetta M., Muñoz Wilson J.T., Beaulieu Montoya A.M., Larrondo Martinez V., [Translated article] Triggered electromyography (tEMG) in the lumbar spine it's reliable? Correlation of tEMG with postoperative CT images in lumbar instrumentation, Revista Española de Cirugía Ortopédica y Traumatología, 66, 2, 2022. Crossref

  9. Beaulieu Lalanne L., Larrondo Carmona R., Alvarez Lemos F., Oelker Behn C., Cáceres Copetta M., Muñoz Wilson J.T., Beaulieu Montoya A.M., Larrondo Martinez V., Electromiografía evocada (tEMG) en la columna lumbar. ¿Es confiable? Correlación de tEMG con imágenes de TC posoperatorias en la instrumentación lumbar, Revista Española de Cirugía Ortopédica y Traumatología, 66, 2, 2022. Crossref

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