Application of different thresholds for instrumentation device testing in minimally invasive lumbosacral spine fixation |
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| Institution: | 1. University of Cantabria, Av los Castros s/n, 39005 Santander, Cantabria, Spain;2. Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, NY, USA;3. Department of Neurosurgery, Mount Sinai West Hospital, New York, NY, USA;4. Department of Neurosurgery, Marqués de Valdecilla University Hospital, Santander, Spain;1. Georgetown University, Washington, DC, USA;2. University of Pittsburgh Medical Center, Pittsburgh, PA, USA;3. Neurological Surgery Spine Services, University of Pittsburgh Medical Center, UMPC – Presbyterian, Suite B400, 200 Lothrop Street, Pittsburgh, PA 15213, USA;1. Department of Neurology and Clinical Neurophysiology, Clinica Fornaca di Sessant, Corso Vittorio Emanuele II, 10128 Turin, Italy;2. Department of Neurosurgery, Clinica Fornaca di Sessant, Corso Vittorio Emanuele II, 10128 Turin, Italy;3. Department of Anesthesiology, CTO Hospital, Via Zuretti 29, 10126 Turin, Italy;1. Faculty of Medicine, University of New South Wales, Sydney 2031, Australia;2. Neurosurgical Research Group (NSURG), Sydney, Australia;3. Department of Neurosurgery, Prince of Wales Hospital, Randwick 2031, Australia;4. Department of Pathology, Prince of Wales Hospital, Randwick 2031, Australia;5. Department of Neurosurgery, Royal Northshore Hospital, St Leonards, Australia;1. Department of Otolaryngology, Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA;2. Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;3. Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA |
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| Abstract: | The main aim of this study was evaluating the reliability of stimulus-evoked electromyography (using different thresholds for stimulation of the instrumentation devices) for minimally invasive pedicle screw placement in the lumbosacral spine. A threshold of 5 mA was applied for the pedicle access needle. 7 mA was applied for the tapscrew and pedicle screw stimulation. The existence of threshold differences between vertebral levels was also assessed. All patients underwent postoperative computed tomography (CT) to determine the accuracy of pedicle screw placement. A total of 172 percutaneous pedicle screws were placed in 52 patients. 94.1% of screws were placed at L4, L5 and S1 vertebral levels. No statistically significant differences existed in thresholds of the pedicle access needles, tapscrews and pedicle screws between vertebral levels. In four instances, the pedicle access needle stimulation had a threshold of 5 mA (no breaches were associated). In the rest of occasions, the pedicle access needles had stimulation thresholds above 5 mA. In all instances, tapscrew and pedicle screw thresholds were above 7 mA; the tapscrews and pedicle screws had significantly greater thresholds than the pedicle access needles. No statistically significant differences existed in thresholds between tapscrews and pedicle screws. Postoperative CT imaging revealed one lateral pedicle violation. Both breach rate and false negative rate were 0.5%. No false positive cases were observed. No patients experienced postoperative pedicle screw–related neurologic deficits. A threshold of 5 mA for the pedicle access needle stimulation seems to be safe. Greater than 7 mA should be used for the tapscrew and pedicle screw stimulation. |
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| Keywords: | EMG Pedicle screw Lumbosacral spine fixation Minimally invasive Threshold Pedicle access needle Tapscrew |
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