Pulse-train versus single-pulse t-EMG stimulation for intraoperative neurophysiologic monitoring of thoracic pedicle screws in adolescent idiopathic scoliosis
To assess the PTS method in neuromonitoring of thoracic pedicle screws in a young cohort of AIS patients. The accuracy of both PTS (Pulse-train stimulation) and SPS (Single-pulse stimulation) techniques in the detection of misplaced thoracic screws was compared with special reference to the screws p...
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| Veröffentlicht in: | Clinical neurology and neurosurgery 2022-04, Vol.215, p.107207-107207, Article 107207 |
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| creator | Montes, Elena de Blas, Gema Barrios, Carlos Mariscal, Gonzalo Burgos, Jesús Regidor, Ignacio Hevia, Eduardo |
| description | To assess the PTS method in neuromonitoring of thoracic pedicle screws in a young cohort of AIS patients. The accuracy of both PTS (Pulse-train stimulation) and SPS (Single-pulse stimulation) techniques in the detection of misplaced thoracic screws was compared with special reference to the screws placed at the concavity and the convexity of the curve.
A single-center prospective clinical cohort study. Level of evidence II. Twelve AIS patients who underwent elective surgery were included in this study. Screw stimulation using repetitive constant-current stimulus train of variable intensities was first performed after screw insertion. SPS was performed immediately after PTS. Postoperatively, CT scan was used to check the final position of the screws. A total of 246 thoracic pedicle screws were placed. Thresholds of screws placed in the convexity and the concavity were compared.
Invasion of the spinal canal was postoperatively confirmed in 29 of the pedicle screws. The SPS technique detected three (10.3%) of these screws using a threshold limit of 12 mA. The PTS technique detected 25 (86.2%) of the 29 misplaced screws using threshold of 30 mA (negative predictive value, 93.1%). When using a PTS threshold of |
| doi_str_mv | 10.1016/j.clineuro.2022.107207 |
| format | Article |
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A single-center prospective clinical cohort study. Level of evidence II. Twelve AIS patients who underwent elective surgery were included in this study. Screw stimulation using repetitive constant-current stimulus train of variable intensities was first performed after screw insertion. SPS was performed immediately after PTS. Postoperatively, CT scan was used to check the final position of the screws. A total of 246 thoracic pedicle screws were placed. Thresholds of screws placed in the convexity and the concavity were compared.
Invasion of the spinal canal was postoperatively confirmed in 29 of the pedicle screws. The SPS technique detected three (10.3%) of these screws using a threshold limit of 12 mA. The PTS technique detected 25 (86.2%) of the 29 misplaced screws using threshold of 30 mA (negative predictive value, 93.1%). When using a PTS threshold of < 20 mA, the positive predictive value was 70%. SPS did not detect any of the misplaced screws at the apex level of the scoliotic curves, and PTS detected 10 out of 17 of these screws. Overall, area under the ROC curve was 0.82 for PTS and 0.61 for SPS.
PTS is a reliable method for detecting medially misplaced screws among young AIS patients undergoing scoliosis surgery. PTS provides more accurate predictions than SPS and improves the identification of screws invading the spinal canal at the apex or near the apex levels.
•PTS thresholds above 30 mA showed high confidence that screws were placed in an intrapedicular position.•Thresholds below 20 mA should alert to a very likely invasion of the spinal canal.•Screws showing PTS thresholds between 20 and 30 mA should be evaluated by another intraoperative technique.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2022.107207</identifier><identifier>PMID: 35334427</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adolescent ; Cohort Studies ; Computed tomography ; Electromyography ; Electromyography - methods ; Humans ; Intraoperative Neurophysiological Monitoring ; Kyphosis ; Nerophysiologic monitoring ; Neurology ; Patients ; Pedicle Screws ; Prospective Studies ; Pulse-train stimulation ; Scoliosis ; Scoliosis - surgery ; Screw misplacement ; Single-pulse screw stimulation ; Spinal cord ; Spinal Fusion - methods ; Surgeons ; Surgery ; Teenagers ; Thoracic Vertebrae - surgery ; Thorax</subject><ispartof>Clinical neurology and neurosurgery, 2022-04, Vol.215, p.107207-107207, Article 107207</ispartof><rights>2022 Elsevier B.V.</rights><rights>Copyright © 2022 Elsevier B.V. All rights reserved.</rights><rights>2022. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c326t-7cf603dc37916e3fbd0f7a5df263150fd739573c1852d7f358442230c3b4eaa73</citedby><cites>FETCH-LOGICAL-c326t-7cf603dc37916e3fbd0f7a5df263150fd739573c1852d7f358442230c3b4eaa73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2643260918?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35334427$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Montes, Elena</creatorcontrib><creatorcontrib>de Blas, Gema</creatorcontrib><creatorcontrib>Barrios, Carlos</creatorcontrib><creatorcontrib>Mariscal, Gonzalo</creatorcontrib><creatorcontrib>Burgos, Jesús</creatorcontrib><creatorcontrib>Regidor, Ignacio</creatorcontrib><creatorcontrib>Hevia, Eduardo</creatorcontrib><title>Pulse-train versus single-pulse t-EMG stimulation for intraoperative neurophysiologic monitoring of thoracic pedicle screws in adolescent idiopathic scoliosis</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>To assess the PTS method in neuromonitoring of thoracic pedicle screws in a young cohort of AIS patients. The accuracy of both PTS (Pulse-train stimulation) and SPS (Single-pulse stimulation) techniques in the detection of misplaced thoracic screws was compared with special reference to the screws placed at the concavity and the convexity of the curve.
A single-center prospective clinical cohort study. Level of evidence II. Twelve AIS patients who underwent elective surgery were included in this study. Screw stimulation using repetitive constant-current stimulus train of variable intensities was first performed after screw insertion. SPS was performed immediately after PTS. Postoperatively, CT scan was used to check the final position of the screws. A total of 246 thoracic pedicle screws were placed. Thresholds of screws placed in the convexity and the concavity were compared.
Invasion of the spinal canal was postoperatively confirmed in 29 of the pedicle screws. The SPS technique detected three (10.3%) of these screws using a threshold limit of 12 mA. The PTS technique detected 25 (86.2%) of the 29 misplaced screws using threshold of 30 mA (negative predictive value, 93.1%). When using a PTS threshold of < 20 mA, the positive predictive value was 70%. SPS did not detect any of the misplaced screws at the apex level of the scoliotic curves, and PTS detected 10 out of 17 of these screws. Overall, area under the ROC curve was 0.82 for PTS and 0.61 for SPS.
PTS is a reliable method for detecting medially misplaced screws among young AIS patients undergoing scoliosis surgery. PTS provides more accurate predictions than SPS and improves the identification of screws invading the spinal canal at the apex or near the apex levels.
•PTS thresholds above 30 mA showed high confidence that screws were placed in an intrapedicular position.•Thresholds below 20 mA should alert to a very likely invasion of the spinal canal.•Screws showing PTS thresholds between 20 and 30 mA should be evaluated by another intraoperative technique.</description><subject>Adolescent</subject><subject>Cohort Studies</subject><subject>Computed tomography</subject><subject>Electromyography</subject><subject>Electromyography - methods</subject><subject>Humans</subject><subject>Intraoperative Neurophysiological Monitoring</subject><subject>Kyphosis</subject><subject>Nerophysiologic monitoring</subject><subject>Neurology</subject><subject>Patients</subject><subject>Pedicle Screws</subject><subject>Prospective Studies</subject><subject>Pulse-train stimulation</subject><subject>Scoliosis</subject><subject>Scoliosis - surgery</subject><subject>Screw misplacement</subject><subject>Single-pulse screw stimulation</subject><subject>Spinal cord</subject><subject>Spinal Fusion - methods</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Teenagers</subject><subject>Thoracic Vertebrae - surgery</subject><subject>Thorax</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU9vVCEUxYnR2LH6FRoSN27eyJ_34M1O07TVpEYXuiYMXDpMePAE3ph-GT9rGad14cYVyeF3D4d7ELqgZE0JFe_3axN8hCWnNSOMNVEyIp-hFR0l68RGjM_RinDCu7EX8gy9KmVPCOFcjC_RGR8473smV-j3tyUU6GrWPuID5LIUXHy8C9DNxxtcu6svN7hUPy1BV58idiljH9tEmiE36QD4T5B5d198CunOGzyl6GvKzQgnh-suZW2aPIP1JgAuJsOv0lywtilAMRAr9tanWddd44pJwafiy2v0wukW483jeY5-XF99v_zU3X69-Xz58bYznInaSeME4dZwuaECuNta4qQerGOC04E4K_lmkNzQcWBWOj6M7feME8O3PWgt-Tl6d_Kdc_q5QKlq8i1VCDpCWopiou8JHQZKGvr2H3SflhxbuiPV4pANHRslTpTJqZQMTs3ZTzrfK0rUsUG1V08NqmOD6tRgG7x4tF-2E9i_Y0-VNeDDCYC2j4OHrIrxEE1bbQZTlU3-f288AL3cs_4</recordid><startdate>202204</startdate><enddate>202204</enddate><creator>Montes, Elena</creator><creator>de Blas, Gema</creator><creator>Barrios, Carlos</creator><creator>Mariscal, Gonzalo</creator><creator>Burgos, Jesús</creator><creator>Regidor, Ignacio</creator><creator>Hevia, Eduardo</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202204</creationdate><title>Pulse-train versus single-pulse t-EMG stimulation for intraoperative neurophysiologic monitoring of thoracic pedicle screws in adolescent idiopathic scoliosis</title><author>Montes, Elena ; 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The accuracy of both PTS (Pulse-train stimulation) and SPS (Single-pulse stimulation) techniques in the detection of misplaced thoracic screws was compared with special reference to the screws placed at the concavity and the convexity of the curve.
A single-center prospective clinical cohort study. Level of evidence II. Twelve AIS patients who underwent elective surgery were included in this study. Screw stimulation using repetitive constant-current stimulus train of variable intensities was first performed after screw insertion. SPS was performed immediately after PTS. Postoperatively, CT scan was used to check the final position of the screws. A total of 246 thoracic pedicle screws were placed. Thresholds of screws placed in the convexity and the concavity were compared.
Invasion of the spinal canal was postoperatively confirmed in 29 of the pedicle screws. The SPS technique detected three (10.3%) of these screws using a threshold limit of 12 mA. The PTS technique detected 25 (86.2%) of the 29 misplaced screws using threshold of 30 mA (negative predictive value, 93.1%). When using a PTS threshold of < 20 mA, the positive predictive value was 70%. SPS did not detect any of the misplaced screws at the apex level of the scoliotic curves, and PTS detected 10 out of 17 of these screws. Overall, area under the ROC curve was 0.82 for PTS and 0.61 for SPS.
PTS is a reliable method for detecting medially misplaced screws among young AIS patients undergoing scoliosis surgery. PTS provides more accurate predictions than SPS and improves the identification of screws invading the spinal canal at the apex or near the apex levels.
•PTS thresholds above 30 mA showed high confidence that screws were placed in an intrapedicular position.•Thresholds below 20 mA should alert to a very likely invasion of the spinal canal.•Screws showing PTS thresholds between 20 and 30 mA should be evaluated by another intraoperative technique.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>35334427</pmid><doi>10.1016/j.clineuro.2022.107207</doi><tpages>1</tpages></addata></record> |
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| ispartof | Clinical neurology and neurosurgery, 2022-04, Vol.215, p.107207-107207, Article 107207 |
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| subjects | Adolescent Cohort Studies Computed tomography Electromyography Electromyography - methods Humans Intraoperative Neurophysiological Monitoring Kyphosis Nerophysiologic monitoring Neurology Patients Pedicle Screws Prospective Studies Pulse-train stimulation Scoliosis Scoliosis - surgery Screw misplacement Single-pulse screw stimulation Spinal cord Spinal Fusion - methods Surgeons Surgery Teenagers Thoracic Vertebrae - surgery Thorax |
| title | Pulse-train versus single-pulse t-EMG stimulation for intraoperative neurophysiologic monitoring of thoracic pedicle screws in adolescent idiopathic scoliosis |
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