Logo image
Back
Role of intraoperative neurophysiologic monitoring in lumbosacral spine fusion and instrumentation: a retrospective study
Journal article   Peer reviewed

Role of intraoperative neurophysiologic monitoring in lumbosacral spine fusion and instrumentation: a retrospective study

Saeid Alemo and Amirali Sayadipour
World neurosurgery, v 73(1)
2010
DOI: https://doi.org/10.1016/j.surneu.2009.04.024
PMID: 20452872
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Intraoperative neurophysiologic monitoring Lumbosacral spine arthrodesis Pedicle screw
This study was carried out to determine the efficacy of IONM in detecting iatrogenic neural injury during pedicle screw insertion, in comparison to the efficacy of computerized tomography (CT) and direct visual inspection of adjacent nerve roots. We reviewed the records of 86 patients, who had had 414 titanium pedicle screws inserted for posterior lumbar instrumentation. A standardized multimodality technique under total intravenous anesthesia was used. A relevant neurophysiologic change (surgical alert) was defined as a reduction in amplitude of at least 50% for somatosensory evoked potentials or at least 65% for transcranial electric motor evoked potentials (tcMEPs) compared with baseline. A stimulation threshold of 8 mA or less indicated that the screw was too close to the nerve root. Immediate feedback via evoked electromyography (EMG) using stimulating pedicle probes in appropriate muscle groups was suggestive of pedicle cortical bone compromise in 28 screws (6.7%). Twenty-one screws were removed and redirected. Four false-positive evoked EMGs in 4 patients were detected by direct visual inspection of the nerve roots and the pedicles, and the surgeon elected not to reposition the screws. None of those patients had postoperative neurologic deficit, and the postoperative CT confirmed the integrity of pedicles. Three false-negative EMGs in 3 patients were detected postoperatively by new neurologic deficits and abnormal CT (3.48%). Intraoperative neurophysiologic monitoring is a valuable tool to add to the surgical skill and intraoperative fluoroscopy to protect neural tissue during pedicle screw instrumentation. However, postoperative CT is the ultimate test to determine the accuracy of positioning of the titanium screws. We propose a wake-up test in the operating room after extubation and urgent CT if the patient develops a new neurologic deficit to determine whether to reposition the screws in the same setting.

Metrics

12 Record Views
39 citations in Web of Science
45 citations in Scopus

Details

UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

InCites Highlights

Data related to this publication, from InCites Benchmarking & Analytics tool:

Web of Science research areas
Clinical Neurology
Surgery
Logo image