We have located links that may give you full text access.
Journal Article
Review
Stimulus-Evoked Electromyographic Monitoring During Minimally Invasive Transpedicular Implantation of Screws in Lumbosacral Spine: Threshold Value, Methodology and Clinical Effectiveness.
World Neurosurgery 2017 Februrary
BACKGROUND: Stimulus-evoked electromyography (EMG) has been developed to increase the safety of transpedicular placement of screws. There is more consensus about this monitoring method in open surgery. Alarm thresholds for minimally invasive surgery are based on referential value for open surgery. Nevertheless, there are no uniform alarm criteria on this modality for minimally invasive surgery. Using an analysis of alarm threshold, methodology and clinical effectiveness on stimulus-evoked EMG monitoring for minimally invasive transpedicular implantation of screws in the lumbosacral spine, this study aims to reflect and recommend for optimizing accuracy.
METHODS: Using a selection of studies, an analysis of the pedicle breach rates and breach-related clinical complication rates was made between studies on minimally invasive surgery by applying different thresholds. A second analysis of the pedicle breach rates and breach-related clinical complication rates was made between studies on open and minimally invasive surgery by applying the same threshold.
RESULTS: In minimally invasive surgery, stimulus-evoked EMG has an acceptable accuracy in the detection of clinical relevant pedicle breaches. Suction limitation may alter the stimulation threshold. No significant differences in clinical effectiveness were observed between studies by applying thresholds of 5 mA, 7 mA, and 12 mA. However, a low threshold of 5 mA seems inappropriate for the tap stimulation.
CONCLUSION: In minimally invasive surgery, continuous stimulation of instrumentation devices is recommended. A minimum 5-mA threshold should be used for stimulation of the pedicle access needle. Use of higher-stimulation thresholds during tapping and incorporation of an adapted continuous suction system may optimize the accuracy of stimulus-evoked EMG.
METHODS: Using a selection of studies, an analysis of the pedicle breach rates and breach-related clinical complication rates was made between studies on minimally invasive surgery by applying different thresholds. A second analysis of the pedicle breach rates and breach-related clinical complication rates was made between studies on open and minimally invasive surgery by applying the same threshold.
RESULTS: In minimally invasive surgery, stimulus-evoked EMG has an acceptable accuracy in the detection of clinical relevant pedicle breaches. Suction limitation may alter the stimulation threshold. No significant differences in clinical effectiveness were observed between studies by applying thresholds of 5 mA, 7 mA, and 12 mA. However, a low threshold of 5 mA seems inappropriate for the tap stimulation.
CONCLUSION: In minimally invasive surgery, continuous stimulation of instrumentation devices is recommended. A minimum 5-mA threshold should be used for stimulation of the pedicle access needle. Use of higher-stimulation thresholds during tapping and incorporation of an adapted continuous suction system may optimize the accuracy of stimulus-evoked EMG.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app