A systematic review with meta-analysis of the diagnostic test accuracy of pedicle screw electrical stimulation

Fonseca, Pedro; Goethel, Márcio Fagundes; Vilas-Boas, João Paulo; Gutierres, Manuel; Correia, Miguel Velhote

doi:10.1007/s00586-022-07218-7

Cited by 2 publications

(2 citation statements)

References 30 publications

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“…Indeed, currents up to 18 mA may be used without the risk of reaching the maximum 400 V compliance voltage of devices such as the Digitimer DS7A (Digitimer, Welwyn Garden City, UK). This may not even be necessary, as current evidence suggests that stimulation currents below 10 mA have a higher diagnostic odds ratio [5]. The experimental results also demonstrate that the total resistance of the pedicle screws, even those with a larger theoretical TiO 2 layer thickness, do not have a high enough electrical resistance to compromise the compliance of the electrical stimulator.…”

Section: Practical Implicationsmentioning

confidence: 83%

“…Ideally, this method would enable the verification of the goodness of pedicle screw insertion without the need for imaging confirmation. However, current evidence has demonstrated a low sensitivity and high specificity of tEMG [5], indicating a high rate of false negatives. Anderson et al [6] suggested that this could be related to high pedicle screw resistance, which led researchers to investigate pedicle screws' electrical properties in uni-and polyaxial titanium screws [6][7][8][9], as well as in those coated with hydroxyapatite [10,11].…”

Section: Introductionmentioning

confidence: 81%

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The Effect of the TiO2 Anodization Layer in Pedicle Screw Conductivity: An Analytical, Numerical, and Experimental Approach

Fonseca,

Goethel,

Vilas-Boas

et al. 2024

Bioengineering

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The electrical stimulation of pedicle screws is a technique used to ensure its correct placement within the vertebrae pedicle. Several authors have studied these screws’ electrical properties with the objective of understanding if they are a potential source of false negatives. As titanium screws are anodized with different thicknesses of a high electrical resistance oxide (TiO2), this study investigated, using analytical, numerical, and experimental methods, how its thickness may affect pedicle screw’s resistance and conductivity. Analytical results have demonstrated that the thickness of the TiO2 layer does result in a significant radial resistance increase (44.21 mΩ/nm, for Ø 4.5 mm), and a decrease of conductivity with layers thicker than 150 nm. The numerical approach denotes that the geometry of the screw further results in a decrease in the pedicle screw conductivity, especially after 125 nm. Additionally, the experimental results demonstrate that there is indeed an effective decrease in conductivity with an increase in the TiO2 layer thickness, which is also reflected in the screw’s total resistance. While the magnitude of the resistance associated with each TiO2 layer thickness may not be enough to compromise the ability to use anodized pedicle screws with a high-voltage electrical stimulator, pedicle screws should be the subject of more frequent electrical characterisation studies.

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Section: Practical Implicationsmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 81%

The Effect of the TiO2 Anodization Layer in Pedicle Screw Conductivity: An Analytical, Numerical, and Experimental Approach

Fonseca,

Goethel,

Vilas-Boas

et al. 2024

Bioengineering

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Intraoperative triggered electromyographic monitoring of pedicle screw efficiently reduces the lumbar pedicle breach and re-operative rate-a retrospective analysis based on postoperative computed tomography scan

Yongjun,

Yuntian,

Biao

et al. 2023

BMC Musculoskelet Disord

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Background To investigate whether intraoperative triggered electromyographic (T-EMG) monitoring could effectively reduce the breach rate of pedicle screws and the revision rate. Methods Patients with posterior pedicle screw fixation from L1-S1 were enrolled between June 2015 and May 2021. The patients in whom T-EMG was utilized were placed in the T-EMG group, and the remaining patients were considered in the non-T-EMG group. Three spine surgeons evaluated the images. The two groups were divided into subgroups based on screw position (lateral/superior and medial/inferior) and breach degree (minor and major). Patient demographics, screw positions, and revision procedures were reviewed. Results A total of 713 patients (3403 screws) who underwent postoperative computed tomography (CT) scans were included. Intraobserver and interobserver reliabilities were perfect. The T-EMG and non-T-EMG groups had 374(1723 screws) and 339 (1680 screws) cases, respectively. T-EMG monitoring efficiently reduced the overall screw breach (T-EMG 7.78% vs. non-T-EMG 11.25%, p = 0.001). in the subgroup analysis, the medial/inferior breach rate was higher in the T-EMG group than in the non-T-EMG group (T-EMG 6.27% vs. non-T-EMG 8.93%, p = 0.002); however, no difference was observed between the lateral and superior breaches (p = 0.064). A significant difference was observed between the minor (T-EMG 6.21% vs. non-T-EMG 8.33%, p = 0.001) and major (T-EMG 0.06% vs. non-T-EMG 0.6%, p = 0.001) medial or inferior screw breach rates. Six screws (all in the non-T-EMG group) underwent revision, with a significant difference between the groups (T-EMG 0.0% vs. non-T-EMG 3.17%, p = 0.044). Conclusions T-EMG is a valuable tool in improving the accuracy of screw placement and reducing the screw revision rate. The screw-nerve root distance is vital in causing symptomatic screw breach. Trial registration The study is retrospective registered in China National Medical Research Registration and Archival information system in Nov 17th 2022.

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A systematic review with meta-analysis of the diagnostic test accuracy of pedicle screw electrical stimulation

Cited by 2 publications

References 30 publications

The Effect of the TiO2 Anodization Layer in Pedicle Screw Conductivity: An Analytical, Numerical, and Experimental Approach

The Effect of the TiO2 Anodization Layer in Pedicle Screw Conductivity: An Analytical, Numerical, and Experimental Approach

Intraoperative triggered electromyographic monitoring of pedicle screw efficiently reduces the lumbar pedicle breach and re-operative rate-a retrospective analysis based on postoperative computed tomography scan

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