Objectivethe aim of this study was to assess the degree of exposure of the orthopedic surgical team to fluoroscopic ionizing radiation.Methodsthe ionizing radiation to which the orthopedic surgical team (R1, R2 and R3) was exposed was assayed using thermoluminescent dosimeters that were distributed in target anatomical regions (regions with and without protection using a lead apron). This was done during 45 hip osteosynthesis procedures to treat transtrochanteric fractures that were classified as 31-A2.1 (AO).Resultsthe radioactive dose received by R3 was 6.33 mSv, R2 4.51 mSv and R3 1.99 mSv (p = 0.33). The thyroid region received 0.86 mSv of radiation, the thoracic region 1.24 mSv and the gonadal region 2.15 mSv (p = 0.25). There was no record of radiation at the dosimeters located below the biosafety protectors or on the team members’ backs.Conclusionsthe members of the surgical team who were located closest to the fluoroscope received greater radiation doses than those located further away. The anatomical regions located below the waistline were the ones that received most ionizing radiation. These results emphasize the importance of using biosafety devices, since these are effective in preventing radiation from reaching the vital organs of the medical team.
<sec><title>OBJECTIVE:</title><p> To analyze the occurrence of poor positioning of pedicle screws inserted with the aid of intraoperative electromyographic stimulation in the treatment of Adolescent Idiopathic Scoliosis (AIS).</p></sec><sec><title>METHODS:</title><p> This is a prospective observational study including all patients undergoing surgical treatment for AIS, between March and December 2013 at a single institution. All procedures were monitored by electromyography of the inserted pedicle screws. The position of the screws was evaluated by assessment of postoperative CT and classified according to the specific AIS classification system.</p></sec><sec><title>RESULTS:</title><p> Sixteen patients were included in the study, totalizing 281 instrumented pedicles (17.5 per patient). No patient had any neurological deficit or complaint after surgery. In the axial plane, 195 screws were found in ideal position (69.4%) while in the sagittal plane, 226 screws were found in ideal position (80.4%). Considering both the axial and the sagittal planes, it was observed that 59.1% (166/281) of the screws did not violate any cortical wall.</p></sec><sec><title>CONCLUSION:</title><p> The use of pedicle screws proved to be a safe technique without causing neurological damage in AIS surgeries, even with the occurrence of poor positioning of some implants.</p></sec>
Background: To investigate in the conventional techniques of the pedicle screws using triggered screw electromyography (t-EMG), considering different threshold cutoffs: 10, 15, 20 25 mA, for predicting pedicle screw positioning during surgery of the adolescent with idiopathic scoliosis (AIS). Methods: Sixteen patients (4 males, 12 females, average age 16.6 years) were included, with an average curve magnitude of 50 degrees and placement of 226 pedicle screws. Each screw was classified as “at risk for nerve injury” (ARNI) or “no risk for nerve injury” (NRNI) using CT and the diagnostic accuracy of EMG considering different threshold cutoffs (10,15, 20 and 25 mA) in the axial and Sagittal planes for predicting screw positions ARNI was investigated. Results: The EMG exam accuracy, in the axial plane, 90.3% screws were considered NRNI. In the sagittal plane, 81% pedicle screws were considered NRNI. A 1-mA decrease in the EMG threshold was associated with a 12% increase in the odds of the screw position ARNI. In the axial and sagittal planes, the ORs were 1.09 and 1.12, respectively. At every threshold cutoff evaluated, the PPV of EMG for predicting screws ARNI was very low in the different threshold cutoff (10 and 15); the highest PPV was 18% with a threshold cutoff of 25 mA. The PPV was always slightly higher for predicting screws ARNI in the sagittal plane than in the axial plane. In contrast, there was a moderate to high NPV (78%-93%) for every cutoff analyzed. Conclusions: EMG had a moderate to high accuracy for positive predicting value screws ARNI with increase threshold cutoffs of 20 and 25 mA. In addition, showed to be effective for minimizing false-negative screws ARNI in the different threshold cutoffs of the EMG in adolescent with idiopathic scoliosis (AIS).
Background: To investigate in the conventional techniques of the pedicle screws using triggered screw electromyography (t-EMG), considering different threshold cutoffs: 10, 15, 20 25 mA, for predicting pedicle screw positioning during surgery of the adolescent with idiopathic scoliosis (AIS). Methods: Sixteen patients (4 males, 12 females, average age 16.6 years) were included, with an average curve magnitude of 50 degrees and placement of 226 pedicle screws. Each screw was classified as "at risk for nerve injury" (ARNI) or "no risk for nerve injury" (NRNI) using CT and the diagnostic accuracy of EMG considering different threshold cutoffs (10,15, 20 and 25 mA) in the axial and Sagittal planes for predicting screw positions ARNI was investigated. Results: The EMG exam accuracy, in the axial plane, 90.3% screws were considered NRNI. In the sagittal plane, 81% pedicle screws were considered NRNI. A 1-mA decrease in the EMG threshold was associated with a 12% increase in the odds of the screw position ARNI. In the axial and sagittal planes, the ORs were 1.09 and 1.12, respectively. At every threshold cutoff evaluated, the PPV of EMG for predicting screws ARNI was very low in the different threshold cutoff (10 and 15); the highest PPV was 18% with a threshold cutoff of 25 mA. The PPV was always slightly higher for predicting screws ARNI in the sagittal plane than in the axial plane. In contrast, there was a moderate to high NPV (78-93%) for every cutoff analyzed. Conclusions: EMG had a moderate to high accuracy for positive predicting value screws ARNI with increase threshold cutoffs of 20 and 25 mA. In addition, showed to be effective for minimizing false-negative screws ARNI in the different threshold cutoffs of the EMG in adolescent with idiopathic scoliosis (AIS).
Introduction Pedicular screw has become the most popular device in spine surgeries, especially in the treatment of adolescent idiopathic scoliosis (AIS). They lead to better curve correction in coronal, sagittal, and rotational planes, shorter constructions, and better pulmonary function compared with other devices. Despite those advantages, this technique is potentially dangerous. Intraoperative neuromonitoring is frequently used to detect the misplacement of screw and reverse possible neurological complications. The aim of this study is to analyze the relation between electromyographic records of the inserted screws and their position by postoperative CT scan. Materials and Methods This is an observational prospective study which includes 16 patients undergoing AIS surgical correction between March and December 2013 at one institution. All procedures were monitored with electromyography (EMG) of the inserted screws and the stimulation threshold of each screw was recorded. Those values were compared with the position of the screws, based on the postoperative CT scan, according to the classification proposed by Abul-Kasim et al. Results Included were 16 patients with 281 pedicles instrumented (17.5 per patient). No patient presented with any neurological deficit or complaints after surgery. In the axial plane, 195 screws were ideally inserted in the pedicles (69.4%) and in the sagittal plane, 226 screws were ideally inserted in the pedicles (80.4%). Considering both the axial and sagittal planes, 166 (59.1%) did not breach any pedicular cortical wall. No statistical correlation was observed between EMG threshold and screw position in the axial CT-scan position, as in the medial or lateral misplacement ( p = 0.425), but statistical significant correlation was observed between EMG threshold and screw position in the sagittal CT-scan position, with smaller results when the screws were misplaced inferiorly, closer to the foraminal roots ( p = 0.017). Conclusion Pedicular screws were safe in this AIS surgery series, even with misplaced position. EMG monitoring has shown to be efficient in identifying misplacement of pedicle screws in the sagittal plane (inferior foraminal perforation) but not so much in identifying the axial plane misplacement (lateral or medial).
Background: To investigate electromyography (EMG) thresholds for predicting pedicle screw positioning during adolescent idiopathic scoliosis (AIS) surgery.Methods: 16 patients were included. Each screw was classified as “at risk for nerve injury” (ARNI) or “no risk for nerve injury” (NRNI) using CT and the diagnostic accuracy of EMG thresholds for predicting screw positions ARNI was investigated.Results: 226 pedicles were analyzed. In the axial plane, 204 (90.3%) screws were considered as NRNI, and 22 (9.7%), as ARNI. In the sagittal plane, 183 (81%) pedicle screws were considered as NRNI, and 43 (19%), as ARNI. We observed a significant association between EMG responses and screw positioning ARNI. A 1-mA decrease in EMG threshold corresponded to a 12% increase in the odds of screw position ARNI (OR=1.12; p<.001). The positive predictive value of EMG for diagnosing ARNI was very low, with the highest 18% corresponding to a cutoff of 25 mA, but the negative predictive value was moderate to high (78%-93%) for every cutoff.Conclusions: EMG had a poor accuracy for predicting screws ARNI but was effective for minimizing false-negative screws ARNI.
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