Retrospective Study of Nerve Injury and Pedicle Screw Breach after Pedicle Screw Fixation with Intraoperative Triggered Electromyography Monitoring
Abstract
Objective: To evaluate the incidence of nerve injury and pedicle breach after pedicle screw fixation (PSF) with intraoperative triggered electromyography (tEMG) monitoring.
Material and Methods: All patients who underwent PSF with intraoperative tEMG at Vajira Hospital between October 2018 and March 2020 were included. Patients with dysmorphic pedicle features, preoperative infection, or incomplete follow-up data were excluded. PSF was done with intraoperative tEMG. The stimulation threshold was recorded. Stimulation threshold <7 mA was not allowed to proceed with the procedure and required reposition of pedicle screw immediately. Post-operative nerve injury was evaluated by physical examination and computer tomography of the spine was done to detect any pedicle breaches. The sensitivity and specificity of intraoperative tEMG to detect pedicle breach were calculated. The risk factors associated with pedicle breach were analyzed.
Results: The records of thirty-six patients with 278 pedicle screws were analyzed. No post-operative nerve injuries were found. The incidence of pedicle breach was 2.2%. The sensitivity and specificity were 83.0% and 91.0%, respectively. The risk factors associated with pedicle breach were degenerative disease and tumor(s) (odds ratio (OR) 3.05, 95% confidence interval (CI) 1.11-8.41, p-value=0.030) and stimulation threshold 7-10 mA (OR 0.02, 95% CI 0.00-0.19, p-value< 0.001).
Conclusion: PSF with intraoperative tEMG was safe for neural integrity. Intraoperative tEMG had the ability to detect pedicle breaches with fair sensitivity and high specificity. Patients with degenerative disease, tumors, or stimulation threshold less than 11 mA had a higher risk of pedicle breach.
Keywords
Full Text:
PDFReferences
Hicks JM, Singla A, Shen FH, Arlet V. Complications of pedicle screw fixation in scoliosis surgery: a systematic review. Spine 2010;35:E465-70.
Esses SI, Sachs BL, Dreyzin V. Complications associated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine 1993;18:2231-9.
Belmont PJ Jr, Klemme WR, Robinson M, Polly DW Jr. Accuracy of thoracic pedicle screws in patients with and without coronal plane spinal deformities. Spine 2002;27:1558-66.
Calancie B, Lebwohl N, Madsen P, Klose KJ. Intraoperative evoked EMG monitoring in an animal model. A new technique for evaluating pedicle screw placement. Spine 1992;17:1229- 35.
Maguire J, Wallace S, Madiga R, Leppanen R, Draper V. Evaluation of intrapedicular screw position using intraoperative evoked electromyography. Spine 1995;20:1068-74.
Gertzbein SD, Robbins SE. Accuracy of pedicular screw placement in vivo. Spine 1990;15:11-4.
Lenke LG, Padberg AM, Russo MH, Bridwell KH, Gelb DE. Triggered electromyographic threshold for accuracy of pedicle screw placement. An animal model and clinical correlation. Spine 1995;20:1585-91.
Wang MY, Pineiro G, Mummaneni PV. Stimulus-evoked electromyography testing of percutaneous pedicle screws for the detection of pedicle breaches: a clinical study of 409 screws in 93 patients. J Neurosurg Spine 2010;13:600-5.
Holdefer RN, Heffez DS, Cohen BA. Utility of evoked EMG monitoring to improve bone screw placements in the cervical spine. J Spinal Disord Tech 2013;26:E163-9.
Moed BR, Ahmad BK, Craig JG, Jacobson GP, Anders MJ. Intraoperative monitoring with stimulus-evoked electromyography during placement of iliosacral screws. An initial clinical study. J Bone Joint Surg Am 1998;80:537-46.
Mikula AL, Williams SK, Anderson PA. The use of intraoperative triggered electromyography to detect misplaced pedicle screws: a systematic review and meta-analysis. J Neurosurg Spine 2016;24:624-38.
Rodriguez-Olaverri JC, Zimick NC, Merola A, De Blas G, Burgos J, Piza-Vallespir G, et al. Using triggered electromyographic threshold in the intercostal muscles to evaluate the accuracy of upper thoracic pedicle screw placement (T3-T6). Spine 2008;33:E194-7.
Raynor BL, Lenke LG, Kim Y, Hanson DS, Wilson-Holden TJ, Bridwell KH, et al. Can triggered electromyograph thresholds predict safe thoracic pedicle screw placement? Spine 2002; 27:2030-5.
Cordemans V, Kaminski L, Banse X, Francq BG, Cartiaux O. Accuracy of a new intraoperative cone beam CT imaging technique (Artis zeego II) compared to postoperative CT scan for assessment of pedicle screws placement and breaches detection. Eur Spine J 2017;26:2906-16.
Refbacks
- There are currently no refbacks.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.