Carelli LE, Almeida LE, Cabrera JP, Khan AA, Mendonça ML, Vital RT, Fonseca GV, Jardim MM. Correlation between Single-pulse and Pulse-train stimulation during Neuromonitoring of Thoracic Pedicle Screws in Scoliosis Surgery.
World Neurosurg 2022;
164:e611-e618. [PMID:
35577202 DOI:
10.1016/j.wneu.2022.05.023]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND
The use of thoracic pedicle screws (TPS) during scoliosis surgery entails an inherent risk of neurological deficit. Triggered electromyography (t-EMG) is an accurate neuromonitoring test for the detection of malpositioned TPS. However, single-pulse t-EMG (SP t-EMG) stimulation has shown variable capability for detecting medial pedicle breaches while pulse-train t-EMG (PT t-EMG) could be more accurate. The aim is to analyze the correlation between SP t-EMG and PT t-EMG.
METHODS
Retrospective study including 20 patients of scoliosis correction with 294 TPS placed. A total of 588 tests with both SP t-EMG and PT t-EMG were performed, analyzed, and compared. The results of both t-EMG techniques were stratified into three different groups according to threshold obtained: Group 1 (≤6 mA), Group 2 (6.1 - 11.9 mA) and Group 3 (=12 mA). Generalized Linear Model was performed to analyze the correlation between the methods.
RESULTS
SP t-EMG elicited response in 5 screws (1.7%) at ≤ 6 mA; 28 screws (9.5%) at 6.1 - 11.9 mA; and 261 screws (88.8%) at =12 mA. PT t-EMG elicited response in 16 screws (5.4%) at ≤6 mA; 30 screws (10.2%) at 6.1 - 11.9mA; and 248 screws (84.4%) at =12 mA. There is a strong positive and significant association between SP t-EMG and PT t-EMG with a decrease ratio of 2% (95% CI: 1% to 3%).
CONCLUSIONS
SP t-EMG and PT t-EMG stimulation techniques had similar results when the stimuli were applied the TPS, but PT t-EMG may have better efficacy in low-threshold group.
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