Transpedicular Stabilization with Freehand Technique on the Thoracic Spine

Cavali, Paulo Tadeu Maia

doi:10.1007/978-3-642-22682-3_36

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…The technical stimulation parameters that we used were: frequency of 3Hz, duration of 0.1ms, with stimulation intensity (milliamperes) increased to provoke the emergence of a response in the EMG. 14,15,18 The maximum stimulation value used was 30 milliamperes (mA).…”

Section: Methodsmentioning

confidence: 99%

“…[11][12][13] For this technique, motor evoked potential (MEP), somatosensory evoked potential (SSEP), free-running electromyography (EMG-FR) and stimulated electromyography (EMG-ST) are used, the latter being performed directly on the inserted implants. 14,15 In patients with scoliosis, due to the rotational deformity, the risk of violation of the medial cortical or lateral wall of the pedicle is even greater, but is not always easy to spot during the surgical procedure. Intraoperative evaluation of the position of the screws with conventional fluoroscopy or radiography will assist in the detection of poorly positioned implants, although the accuracy obtained with computed tomography (CT) will be greater for this determination.…”

Section: Introductionmentioning

confidence: 99%

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Positioning of pedicle screws in adolescent idiopathic scoliosis using electromyography

et al. 2015

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<sec><title>OBJECTIVE:</title> 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).</sec><sec><title>METHODS:</title> 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.</sec><sec><title>RESULTS:</title> 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.</sec><sec><title>CONCLUSION:</title> 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.</sec>

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Positioning of pedicle screws in adolescent idiopathic scoliosis using electromyography

et al. 2015

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“…After pedicle screw insertion, EMG was performed by directly stimulating the implants, using a monopolar electrode (cathode) and a subdermal needle electrode inserted into the paravertebral musculature (anode). Stimulation was performed with a frequency of 3 Hz, a duration of 0.1 ms and an increasing intensity until an EMG response could be observed [12]. The maximum intensity used was 30 milli-amperes (mA).…”

Section: Variables and Measurementsmentioning

confidence: 99%

Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

Barsotti

Gavassi

Prado

et al. 2020

Preprint

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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).

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“…Stimulation was performed with a frequency of 3 Hz, a duration of 0.1 ms and an increasing intensity until an EMG response could be observed [12]. The maximum intensity used was 30 milli-amperes (mA).…”

Section: Variables and Measurementsmentioning

confidence: 99%

“…Motor evoked potentials, somatosensory evoked potentials, free-running electromyography (EMG) and stimulated EMG can be used as monitoring techniques. Furthermore, stimulated EMG can be applied directly to the inserted screws [12].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

Barsotti

Gavassi

Prado

et al. 2020

Preprint

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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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Transpedicular Stabilization with Freehand Technique on the Thoracic Spine

Cited by 4 publications

References 6 publications

Positioning of pedicle screws in adolescent idiopathic scoliosis using electromyography

Positioning of pedicle screws in adolescent idiopathic scoliosis using electromyography

Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

Diagnostic accuracy of perioperative electromyography in the positioning of pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional diagnostic study

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