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Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion

PURPOSE: The lateral transpsoas interbody fusion (LTIF) is an increasingly popular minimally invasive technique for lumbar interbody fusion. Although a posterior approach to the lumbar spine has traditionally been favored for the treatment of canal stenosis and neural foraminal stenosis, a growing b...

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Autores principales: Woodall, Michael Neil, Shakir, Basheer, Smitherman, Adam, Choudhri, Haroon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier, Inc. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300971/
https://www.ncbi.nlm.nih.gov/pubmed/25694902
http://dx.doi.org/10.1016/j.ijsp.2013.02.002
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author Woodall, Michael Neil
Shakir, Basheer
Smitherman, Adam
Choudhri, Haroon
author_facet Woodall, Michael Neil
Shakir, Basheer
Smitherman, Adam
Choudhri, Haroon
author_sort Woodall, Michael Neil
collection PubMed
description PURPOSE: The lateral transpsoas interbody fusion (LTIF) is an increasingly popular minimally invasive technique for lumbar interbody fusion. Although a posterior approach to the lumbar spine has traditionally been favored for the treatment of canal stenosis and neural foraminal stenosis, a growing body of evidence suggests that indirect decompression of the spinal canal and neural foramen can be achieved using a lateral transpsoas approach to the lumbar spine. We present 2 cases that may suggest a role for spontaneous electromyography (s-EMG) monitoring in assessing the adequacy of decompression during LTIF. METHODS: The 2 cases presented in this technical note illustrate resolution of s-EMG firing during LTIF, following distraction across the disk space. Removal of the distracting device produced the return of s-EMG firing. Both of these cases were operated at the L2-3 level. RESULTS: In the first case, s-EMG firing was noted in the bilateral tibialis anterior leads. Resolution of EMG firing may suggest indirect decompression of the canal via ligamentotaxis as the L5 root traverses the L2-3 disk space. In the second case, s-EMG firing was noted in the left abductor hallucis and resolved with distraction of the L2-3 disk space. Again, this may be explained by canal decompression via ligamentotaxis as the S1 root traverses the L2-3 disk space. CONCLUSION: In both cases, distraction across the disk space resulted in resolution of s-EMG discharges—this correlated with an improvement in symptoms. These findings may suggest a role for s-EMG as a marker for adequacy of decompression in a select subset of patients undergoing LTIF. Further study is needed to determine if resolution of s-EMG is a useful measure of indirect decompression during LTIF.
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spelling pubmed-43009712015-02-18 Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion Woodall, Michael Neil Shakir, Basheer Smitherman, Adam Choudhri, Haroon Int J Spine Surg Full Length Article PURPOSE: The lateral transpsoas interbody fusion (LTIF) is an increasingly popular minimally invasive technique for lumbar interbody fusion. Although a posterior approach to the lumbar spine has traditionally been favored for the treatment of canal stenosis and neural foraminal stenosis, a growing body of evidence suggests that indirect decompression of the spinal canal and neural foramen can be achieved using a lateral transpsoas approach to the lumbar spine. We present 2 cases that may suggest a role for spontaneous electromyography (s-EMG) monitoring in assessing the adequacy of decompression during LTIF. METHODS: The 2 cases presented in this technical note illustrate resolution of s-EMG firing during LTIF, following distraction across the disk space. Removal of the distracting device produced the return of s-EMG firing. Both of these cases were operated at the L2-3 level. RESULTS: In the first case, s-EMG firing was noted in the bilateral tibialis anterior leads. Resolution of EMG firing may suggest indirect decompression of the canal via ligamentotaxis as the L5 root traverses the L2-3 disk space. In the second case, s-EMG firing was noted in the left abductor hallucis and resolved with distraction of the L2-3 disk space. Again, this may be explained by canal decompression via ligamentotaxis as the S1 root traverses the L2-3 disk space. CONCLUSION: In both cases, distraction across the disk space resulted in resolution of s-EMG discharges—this correlated with an improvement in symptoms. These findings may suggest a role for s-EMG as a marker for adequacy of decompression in a select subset of patients undergoing LTIF. Further study is needed to determine if resolution of s-EMG is a useful measure of indirect decompression during LTIF. Elsevier, Inc. 2013-12-01 /pmc/articles/PMC4300971/ /pubmed/25694902 http://dx.doi.org/10.1016/j.ijsp.2013.02.002 Text en © 2013 ISASS - The International Society for the Advancement of Spine Surgery. Published by Elsevier Inc. All rights reserved. http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Full Length Article
Woodall, Michael Neil
Shakir, Basheer
Smitherman, Adam
Choudhri, Haroon
Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion
title Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion
title_full Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion
title_fullStr Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion
title_full_unstemmed Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion
title_short Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion
title_sort technical note: resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion
topic Full Length Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4300971/
https://www.ncbi.nlm.nih.gov/pubmed/25694902
http://dx.doi.org/10.1016/j.ijsp.2013.02.002
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