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Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion
BACKGROUND: The standard of care is to utilize intraoperative neurophysiological monitoring (IOM) of triggered electromyography (tEMG) during posterior lumbosacral instrumented-fusion surgery. IOM should theoretically signal misplacement of S1 screws into the neural L5–S1 foramen or spinal canal, ut...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Scientific Scholar
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110297/ https://www.ncbi.nlm.nih.gov/pubmed/32257568 http://dx.doi.org/10.25259/SNI_4_2020 |
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author | Cousiño, Juan P. Cabrera Luna, Francisco Torche, Máximo Vigueras, Sebastián Torche, Esteban Valdés, Guillermo |
author_facet | Cousiño, Juan P. Cabrera Luna, Francisco Torche, Máximo Vigueras, Sebastián Torche, Esteban Valdés, Guillermo |
author_sort | Cousiño, Juan P. Cabrera |
collection | PubMed |
description | BACKGROUND: The standard of care is to utilize intraoperative neurophysiological monitoring (IOM) of triggered electromyography (tEMG) during posterior lumbosacral instrumented-fusion surgery. IOM should theoretically signal misplacement of S1 screws into the neural L5–S1 foramen or spinal canal, utilizing screw stimulation, and recording of the lower limb muscles and the anal sphincter. Here, we evaluated when and whether anterolateral S1 screw malposition could be detected by IOM/tEMG during open posterior lumbosacral instrumented fusion surgery. METHODS: tEMG, somatosensory-evoked potential (SSEP), and transcranial electrical motor-evoked potential (TcMEP) data were retrospectively reviewed from 2015 to 2017 during open posterior lumbosacral instrumented fusions. We utilized screw stimulation alert thresholds of <14 mA (tEMG) and recorded from the lower extremity muscles and anal sphincter. Furthermore, all patients underwent routine postoperative computed tomography (CT) scans to confirm the screw location. RESULTS: There were 106 S1 screws placed in 54 patients: 52 bilateral and 2 unilateral. In 6 patients (11.1%), 7 screws (6.6%) registered at low tEMG thresholds. In 1 patient, the postoperative CT scan documented external malposition of the screw despite no intraoperative IOM/tEMG alert. When S1 misplaced screws were stimulated, the most sensitive muscle was the tibialis anterior; the sensitivity of the IOM/tEMG was 87.5%, the specificity was 97.9%, the positive predictive value was 77.8%, and the negative predictive value was 98.9%. TcMEP and SSEP did not change during any of the operations. Notably, no patient developed a new neurological deficit. CONCLUSION: Anterolateral S1 screw malposition can be detected accurately utilizing IOM/tEMG stimulation of screws. When alerts occur, they can largely be corrected by partially backing out the screw (e.g., a few turns) and/ or changing the screw trajectory. |
format | Online Article Text |
id | pubmed-7110297 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Scientific Scholar |
record_format | MEDLINE/PubMed |
spelling | pubmed-71102972020-04-01 Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion Cousiño, Juan P. Cabrera Luna, Francisco Torche, Máximo Vigueras, Sebastián Torche, Esteban Valdés, Guillermo Surg Neurol Int Original Article BACKGROUND: The standard of care is to utilize intraoperative neurophysiological monitoring (IOM) of triggered electromyography (tEMG) during posterior lumbosacral instrumented-fusion surgery. IOM should theoretically signal misplacement of S1 screws into the neural L5–S1 foramen or spinal canal, utilizing screw stimulation, and recording of the lower limb muscles and the anal sphincter. Here, we evaluated when and whether anterolateral S1 screw malposition could be detected by IOM/tEMG during open posterior lumbosacral instrumented fusion surgery. METHODS: tEMG, somatosensory-evoked potential (SSEP), and transcranial electrical motor-evoked potential (TcMEP) data were retrospectively reviewed from 2015 to 2017 during open posterior lumbosacral instrumented fusions. We utilized screw stimulation alert thresholds of <14 mA (tEMG) and recorded from the lower extremity muscles and anal sphincter. Furthermore, all patients underwent routine postoperative computed tomography (CT) scans to confirm the screw location. RESULTS: There were 106 S1 screws placed in 54 patients: 52 bilateral and 2 unilateral. In 6 patients (11.1%), 7 screws (6.6%) registered at low tEMG thresholds. In 1 patient, the postoperative CT scan documented external malposition of the screw despite no intraoperative IOM/tEMG alert. When S1 misplaced screws were stimulated, the most sensitive muscle was the tibialis anterior; the sensitivity of the IOM/tEMG was 87.5%, the specificity was 97.9%, the positive predictive value was 77.8%, and the negative predictive value was 98.9%. TcMEP and SSEP did not change during any of the operations. Notably, no patient developed a new neurological deficit. CONCLUSION: Anterolateral S1 screw malposition can be detected accurately utilizing IOM/tEMG stimulation of screws. When alerts occur, they can largely be corrected by partially backing out the screw (e.g., a few turns) and/ or changing the screw trajectory. Scientific Scholar 2020-03-06 /pmc/articles/PMC7110297/ /pubmed/32257568 http://dx.doi.org/10.25259/SNI_4_2020 Text en Copyright: © 2020 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Cousiño, Juan P. Cabrera Luna, Francisco Torche, Máximo Vigueras, Sebastián Torche, Esteban Valdés, Guillermo Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion |
title | Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion |
title_full | Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion |
title_fullStr | Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion |
title_full_unstemmed | Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion |
title_short | Anterolateral S1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion |
title_sort | anterolateral s1 screw malposition detected with intraoperative neurophysiological monitoring during posterior lumbosacral fusion |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110297/ https://www.ncbi.nlm.nih.gov/pubmed/32257568 http://dx.doi.org/10.25259/SNI_4_2020 |
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