Automated Intraoperative EMG Testing During Percutaneous Pedicle Screw Placement

Ozgur, Burak M.; Berta, Scott C.; Khiatani, Vishal; Taylor, William R.

doi:10.1016/j.spinee.2005.07.005

Cited by 23 publications

(23 citation statements)

References 30 publications

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“…However, possible concerns of bypassing the electrocautery system and bovie pad possibly resulting in burns have led us to use the classic method of pedicle screw stimulation. If one uses percutaneous insertion of pedicle screws, one should be aware that tapping of the screw path may increase the threshold by compacting the dense trabecular bone [44]. The use of plastic sheet around the pedicle probe will also give a better accuracy of the monitoring by optimizing the thresholds [12].…”

Section: Surgical Considerationsmentioning

confidence: 99%

Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon

2007

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Optimal outcome in spine surgery is dependent of the coordination of efforts by the surgeon, anesthesiologist, and neurophysiologist. This is perhaps best illustrated by the rising use of intraoperative spinal cord monitoring for complex spine surgery. The challenges presented by neurophysiologic monitoring, in particular the use of somatosensory and motor evoked potentials, requires an understanding by each member for the team of the proposed operative procedure as well as an ability to help differentiate clinically important signal changes from false positive changes. Surgical, anesthetic, and monitoring issues need to be addressed when relying on this form of monitoring to reduce the potential of negative outcomes in spine surgery. This article provides a practical overview from the perspective of the neurophysiologist, the anesthesiologist, and the surgeon on the requirements which must be understood by these participants in order to successfully contribute to a positive outcome when a patient is undergoing complex spine surgery.

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Section: Surgical Considerationsmentioning

confidence: 99%

Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon

2007

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“…Ozgur et al 22. pointed out that tapping often improved thresholds in EMG testing to identify suboptimal screw trajectories in minimally invasive pedicle screw fixation, perhaps by compressing the bone and creating a denser, more insulative pedicle wall.…”

Section: Discussionmentioning

confidence: 99%

“…Limbrick and Wright23 showed that significantly higher stimulus intensities were required to evoke myogenic responses from chronically compressed nerve roots compared with normal nerve roots. There were many studies about the utility of EMG testing in percutaneous pedicle screw fixation techniques 222425. Ozgur et al 22.…”

Section: Discussionmentioning

confidence: 99%

“…There were many studies about the utility of EMG testing in percutaneous pedicle screw fixation techniques 222425. Ozgur et al 22. used the initial fluoroscopically guided k-wires and the subsequent taps were insulated and stimulated via an automated EMG system, then pointed out that EMG testing helps to identify suboptimal screw trajectories, allowing for early adjustment and confirmation of improved placement.…”

Section: Discussionmentioning

confidence: 99%

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Solid and hollow pedicle screws affect the electrical resistance: A potential source of error with stimulus-evoked electromyography

Wang

Liao

et al. 2013

IJOO

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Background:Although stimulus evoked electromyography (EMG) is commonly used to confirm the accuracy of pedicle screw placement. There are no studies to differentiate between solid screws and hollow screws to the electrical resistance of pedicle screws. We speculate that the electrical resistance of the solid and hollow pedicle screws may be different and then a potential source of error with stimulus-evoked EMG may happen.Materials and Methods:Resistance measurements were obtained from 12 pedicle screw varieties (6 screws of each manufacturer) across the screw shank based on known constant current and measured voltage. The voltage was measured 5 times at each site.Results:Resistance of all solid screws ranged from 0.084 Ω to 0.151 Ω (mean =0.118 ± 0.024 Ω) and hollow screws ranged from 0.148 Ω to 0.402 Ω (mean = 0.285 ± 0.081 Ω). There was a significant difference of resistance between the solid screws and hollow screws (P < 0.05). The screw with the largest diameter no matter solid screws or hollow screws had lower resistance than screws with other diameters. No matter in solid screws group or hollow screws group, there were significant differences (P < 0.05) between the 5.0 mm screws and 6.0 mm screws, 6.0 mm screws and 7.0 mm screws, 5.0 mm screws and 7.0 mm screws, 4.5 mm screws and 5.5 mm screws, 5.5 mm screws and 6.5 mm screws, 4.5 mm screws and 6.5 mm screws. The resistance of hollow screws was much larger than the solid screws in the same diameter group (P < 0.05).Conclusions:Hollow pedicle screws have the potential for high electrical resistance compared to the solid pedicle screws and therefore may affect the EMG response during stimulus-evoked EMG testing in pedicle screw fixation especially in minimally invasive percutaneous pedical screw fixation surgery.

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“…26 Neuromonitoring (nerve root monitoring) should also be used to foretell any breech of pedicle, or encroachment on nearby neural structures, which increases the sensitivity of identifying misplaced screws. 27,28 A specific set of instrumentation is necessary for the placement of percutaneous pedicle screws. Many proprietary sets exist, all with the same purpose of cannulating each pedicle in a percutaneous manner with the purpose of dilating through the muscle to avoid extensive dissection and denervation (Fig.…”

Section: Preoperative Planningmentioning

confidence: 99%

Placement of Percutaneous Pedicle Screws

Chao¹

2011

Techniques in Orthopaedics

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Goals of minimally invasive spine surgery are to provide a less traumatic way to accomplish the same goals of traditional open spinal surgery. Techniques have been utilized for treatment of a wide array of spinal conditions including degenerative spinal conditions, scoliosis, trauma, tumor, in both children and adults. Regarding instrumentation, the placement of percutaneous pedicle screws has been the cornerstone of spinal fixation in the minimally invasive approach to the spine for the treatment of a variety of spinal conditions.

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Automated Intraoperative EMG Testing During Percutaneous Pedicle Screw Placement

Cited by 23 publications

References 30 publications

Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon

Current approach on spinal cord monitoring: the point of view of the neurologist, the anesthesiologist and the spine surgeon

Solid and hollow pedicle screws affect the electrical resistance: A potential source of error with stimulus-evoked electromyography

Placement of Percutaneous Pedicle Screws

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