Can Triggered electromyograph thresholds predict safe thoracic pedicle screw placement?
A prospective clinical study of thoracic pedicle screws monitored with triggered electromyographic testing. To evaluate the sensitivity of recording rectus abdominis triggered electromyographs to assess thoracic screw placement. Triggered electromyographic testing from lower extremity myotomes has i...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2002-09, Vol.27 (18), p.2030-2035 |
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| container_title | Spine (Philadelphia, Pa. 1976) |
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| creator | RAYNOR, Barry L LENKE, Lawrence G YONGJUNG KIM HANSON, Darrell S WILSON-HOLDEN, Tracy J BRIDWELL, Keith H PADBERG, Anne M |
| description | A prospective clinical study of thoracic pedicle screws monitored with triggered electromyographic testing.
To evaluate the sensitivity of recording rectus abdominis triggered electromyographs to assess thoracic screw placement.
Triggered electromyographic testing from lower extremity myotomes has identified medially placed lumbar pedicle screws. Higher thresholds indicate intraosseous placement because of increased resistance to current flow. Lower thresholds correspond to compromised pedicles with potential for nerve impingement. No clinical study has correlated an identical technique with rectus muscle recordings, which are innervated from T6 to T12.
A total of 677 thoracic screws were placed in 92 consecutive patients. Screws placed from T6 and T12 were evaluated using an ascending method of stimulation until a compound muscle action potential was obtained from the rectus abdominis. Threshold values were compared both in absolute terms and also in relation to other intrapatient values.
Screws were separated into three groups: Group A (n = 650 screws) had thresholds >6.0 mA and intraosseus placement. Group B (n = 21) had thresholds |
| doi_str_mv | 10.1097/00007632-200209150-00012 |
| format | Article |
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To evaluate the sensitivity of recording rectus abdominis triggered electromyographs to assess thoracic screw placement.
Triggered electromyographic testing from lower extremity myotomes has identified medially placed lumbar pedicle screws. Higher thresholds indicate intraosseous placement because of increased resistance to current flow. Lower thresholds correspond to compromised pedicles with potential for nerve impingement. No clinical study has correlated an identical technique with rectus muscle recordings, which are innervated from T6 to T12.
A total of 677 thoracic screws were placed in 92 consecutive patients. Screws placed from T6 and T12 were evaluated using an ascending method of stimulation until a compound muscle action potential was obtained from the rectus abdominis. Threshold values were compared both in absolute terms and also in relation to other intrapatient values.
Screws were separated into three groups: Group A (n = 650 screws) had thresholds >6.0 mA and intraosseus placement. Group B (n = 21) had thresholds <6.0 mA but an intact medial pedicle border on reexamination and radiographic confirmation. Group C (n = 6) had thresholds <6.0 mA and medial wall perforations confirmed by tactile and/or visual inspection. Thus, 3.9% (27 of 677) of all screws had thresholds <6.0 mA. Only 22% (6 of 27) had medial perforation. Group B screws averaged a 54% decrease from the mean as compared with a 69% decrease for Group C screws (P = 0.0160). There were no postoperative neurologic deficits or radicular chest wall complaints.
To assess thoracic pedicle screw placement, triggered electromyographic thresholds <6.0 mA, coupled with values 60-65% decreased from the mean of all other thresholds in a given patient, should alert the surgeon to suspect a medial pedicle wall breach.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/00007632-200209150-00012</identifier><identifier>PMID: 12634564</identifier><identifier>CODEN: SPINDD</identifier><language>eng</language><publisher>Philadelphia, PA: Lippincott</publisher><subject>Action Potentials - physiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Bone Screws - adverse effects ; Child ; Electric Stimulation - methods ; Electromyography - methods ; Humans ; Medical sciences ; Middle Aged ; Monitoring, Intraoperative - methods ; Orthopedic surgery ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Predictive Value of Tests ; Prospective Studies ; Rectus Abdominis - innervation ; Rectus Abdominis - physiology ; Sensitivity and Specificity ; Sensory Thresholds - physiology ; Spinal Cord Injuries - etiology ; Spinal Cord Injuries - prevention & control ; Spinal Diseases - surgery ; Spinal Fusion - adverse effects ; Spinal Fusion - instrumentation ; Spinal Fusion - methods ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Thoracic Vertebrae - innervation ; Thoracic Vertebrae - surgery</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2002-09, Vol.27 (18), p.2030-2035</ispartof><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-3768b915a82b74db41822aa1f3d100c4fec264fba9bc72c1d6187c6703e219773</citedby><cites>FETCH-LOGICAL-c370t-3768b915a82b74db41822aa1f3d100c4fec264fba9bc72c1d6187c6703e219773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13925748$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12634564$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>RAYNOR, Barry L</creatorcontrib><creatorcontrib>LENKE, Lawrence G</creatorcontrib><creatorcontrib>YONGJUNG KIM</creatorcontrib><creatorcontrib>HANSON, Darrell S</creatorcontrib><creatorcontrib>WILSON-HOLDEN, Tracy J</creatorcontrib><creatorcontrib>BRIDWELL, Keith H</creatorcontrib><creatorcontrib>PADBERG, Anne M</creatorcontrib><title>Can Triggered electromyograph thresholds predict safe thoracic pedicle screw placement?</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>A prospective clinical study of thoracic pedicle screws monitored with triggered electromyographic testing.
To evaluate the sensitivity of recording rectus abdominis triggered electromyographs to assess thoracic screw placement.
Triggered electromyographic testing from lower extremity myotomes has identified medially placed lumbar pedicle screws. Higher thresholds indicate intraosseous placement because of increased resistance to current flow. Lower thresholds correspond to compromised pedicles with potential for nerve impingement. No clinical study has correlated an identical technique with rectus muscle recordings, which are innervated from T6 to T12.
A total of 677 thoracic screws were placed in 92 consecutive patients. Screws placed from T6 and T12 were evaluated using an ascending method of stimulation until a compound muscle action potential was obtained from the rectus abdominis. Threshold values were compared both in absolute terms and also in relation to other intrapatient values.
Screws were separated into three groups: Group A (n = 650 screws) had thresholds >6.0 mA and intraosseus placement. Group B (n = 21) had thresholds <6.0 mA but an intact medial pedicle border on reexamination and radiographic confirmation. Group C (n = 6) had thresholds <6.0 mA and medial wall perforations confirmed by tactile and/or visual inspection. Thus, 3.9% (27 of 677) of all screws had thresholds <6.0 mA. Only 22% (6 of 27) had medial perforation. Group B screws averaged a 54% decrease from the mean as compared with a 69% decrease for Group C screws (P = 0.0160). There were no postoperative neurologic deficits or radicular chest wall complaints.
To assess thoracic pedicle screw placement, triggered electromyographic thresholds <6.0 mA, coupled with values 60-65% decreased from the mean of all other thresholds in a given patient, should alert the surgeon to suspect a medial pedicle wall breach.</description><subject>Action Potentials - physiology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Bone Screws - adverse effects</subject><subject>Child</subject><subject>Electric Stimulation - methods</subject><subject>Electromyography - methods</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative - methods</subject><subject>Orthopedic surgery</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Rectus Abdominis - innervation</subject><subject>Rectus Abdominis - physiology</subject><subject>Sensitivity and Specificity</subject><subject>Sensory Thresholds - physiology</subject><subject>Spinal Cord Injuries - etiology</subject><subject>Spinal Cord Injuries - prevention & control</subject><subject>Spinal Diseases - surgery</subject><subject>Spinal Fusion - adverse effects</subject><subject>Spinal Fusion - instrumentation</subject><subject>Spinal Fusion - methods</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Thoracic Vertebrae - innervation</subject><subject>Thoracic Vertebrae - surgery</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkMtOwzAQRS0EoqXwC8gb2AX8iu2sEKp4SZXYFLG0HGfSBjlNsFOh_j0uDeDNSHfOeEYHIUzJDSWFuiXpKclZxghhpKA5yVJC2RGa0pzpjNK8OEZTwmVCBJcTdBbjR0Ikp8UpmlAmucilmKL3ud3gZWhWKwhQYfDghtC1u24VbL_GwzpAXHe-irhP_cYNONoaUt4F6xqH-33oAUcX4Av33jpoYTPcnaOT2voIF2OdobfHh-X8OVu8Pr3M7xeZ44oMGVdSl-l-q1mpRFUKqhmzlta8ooQ4UYNjUtSlLUqnmKOVpFo5qQgHRgul-AxdH_7tQ_e5hTiYtokOvLcb6LbRKKalEJonUB9AF7oYA9SmD01rw85QYvZSza9U8yfV_EhNo5fjjm3ZQvU_OFpMwNUI2Oisr4PduCb-c7xguUpHfAP10X9V</recordid><startdate>20020915</startdate><enddate>20020915</enddate><creator>RAYNOR, Barry L</creator><creator>LENKE, Lawrence G</creator><creator>YONGJUNG KIM</creator><creator>HANSON, Darrell S</creator><creator>WILSON-HOLDEN, Tracy J</creator><creator>BRIDWELL, Keith H</creator><creator>PADBERG, Anne M</creator><general>Lippincott</general><scope>IQODW</scope><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>7X8</scope></search><sort><creationdate>20020915</creationdate><title>Can Triggered electromyograph thresholds predict safe thoracic pedicle screw placement?</title><author>RAYNOR, Barry L ; LENKE, Lawrence G ; YONGJUNG KIM ; HANSON, Darrell S ; WILSON-HOLDEN, Tracy J ; BRIDWELL, Keith H ; PADBERG, Anne M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c370t-3768b915a82b74db41822aa1f3d100c4fec264fba9bc72c1d6187c6703e219773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Action Potentials - physiology</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Bone Screws - adverse effects</topic><topic>Child</topic><topic>Electric Stimulation - methods</topic><topic>Electromyography - methods</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Orthopedic surgery</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Rectus Abdominis - innervation</topic><topic>Rectus Abdominis - physiology</topic><topic>Sensitivity and Specificity</topic><topic>Sensory Thresholds - physiology</topic><topic>Spinal Cord Injuries - etiology</topic><topic>Spinal Cord Injuries - prevention & control</topic><topic>Spinal Diseases - surgery</topic><topic>Spinal Fusion - adverse effects</topic><topic>Spinal Fusion - instrumentation</topic><topic>Spinal Fusion - methods</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Thoracic Vertebrae - innervation</topic><topic>Thoracic Vertebrae - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>RAYNOR, Barry L</creatorcontrib><creatorcontrib>LENKE, Lawrence G</creatorcontrib><creatorcontrib>YONGJUNG KIM</creatorcontrib><creatorcontrib>HANSON, Darrell S</creatorcontrib><creatorcontrib>WILSON-HOLDEN, Tracy J</creatorcontrib><creatorcontrib>BRIDWELL, Keith H</creatorcontrib><creatorcontrib>PADBERG, Anne M</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>RAYNOR, Barry L</au><au>LENKE, Lawrence G</au><au>YONGJUNG KIM</au><au>HANSON, Darrell S</au><au>WILSON-HOLDEN, Tracy J</au><au>BRIDWELL, Keith H</au><au>PADBERG, Anne M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can Triggered electromyograph thresholds predict safe thoracic pedicle screw placement?</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2002-09-15</date><risdate>2002</risdate><volume>27</volume><issue>18</issue><spage>2030</spage><epage>2035</epage><pages>2030-2035</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>A prospective clinical study of thoracic pedicle screws monitored with triggered electromyographic testing.
To evaluate the sensitivity of recording rectus abdominis triggered electromyographs to assess thoracic screw placement.
Triggered electromyographic testing from lower extremity myotomes has identified medially placed lumbar pedicle screws. Higher thresholds indicate intraosseous placement because of increased resistance to current flow. Lower thresholds correspond to compromised pedicles with potential for nerve impingement. No clinical study has correlated an identical technique with rectus muscle recordings, which are innervated from T6 to T12.
A total of 677 thoracic screws were placed in 92 consecutive patients. Screws placed from T6 and T12 were evaluated using an ascending method of stimulation until a compound muscle action potential was obtained from the rectus abdominis. Threshold values were compared both in absolute terms and also in relation to other intrapatient values.
Screws were separated into three groups: Group A (n = 650 screws) had thresholds >6.0 mA and intraosseus placement. Group B (n = 21) had thresholds <6.0 mA but an intact medial pedicle border on reexamination and radiographic confirmation. Group C (n = 6) had thresholds <6.0 mA and medial wall perforations confirmed by tactile and/or visual inspection. Thus, 3.9% (27 of 677) of all screws had thresholds <6.0 mA. Only 22% (6 of 27) had medial perforation. Group B screws averaged a 54% decrease from the mean as compared with a 69% decrease for Group C screws (P = 0.0160). There were no postoperative neurologic deficits or radicular chest wall complaints.
To assess thoracic pedicle screw placement, triggered electromyographic thresholds <6.0 mA, coupled with values 60-65% decreased from the mean of all other thresholds in a given patient, should alert the surgeon to suspect a medial pedicle wall breach.</abstract><cop>Philadelphia, PA</cop><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>12634564</pmid><doi>10.1097/00007632-200209150-00012</doi><tpages>6</tpages></addata></record> |
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| subjects | Action Potentials - physiology Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Bone Screws - adverse effects Child Electric Stimulation - methods Electromyography - methods Humans Medical sciences Middle Aged Monitoring, Intraoperative - methods Orthopedic surgery Postoperative Complications - etiology Postoperative Complications - prevention & control Predictive Value of Tests Prospective Studies Rectus Abdominis - innervation Rectus Abdominis - physiology Sensitivity and Specificity Sensory Thresholds - physiology Spinal Cord Injuries - etiology Spinal Cord Injuries - prevention & control Spinal Diseases - surgery Spinal Fusion - adverse effects Spinal Fusion - instrumentation Spinal Fusion - methods Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Thoracic Vertebrae - innervation Thoracic Vertebrae - surgery |
| title | Can Triggered electromyograph thresholds predict safe thoracic pedicle screw placement? |
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