A CT-based study investigating the relationship between pedicle screw placement and stimulation threshold of compound muscle action potentials measured by intraoperative neurophysiological monitoring

Object There is considerable variation in the use of adjunctive technologies to confirm pedicle screw placement. Although there is literature to support the use of both neurophysiological monitoring and isocentric fluoroscopy to confirm pedicle screw positioning, there are no studies examining the cost-effectiveness of these technologies. This study compares the cost-effectiveness and efficacy of isocentric O-arm fluoroscopy, neurophysiological monitoring, and postoperative CT scanning after multilevel instrumented fusion for degenerative lumbar disease. Methods Retrospective data were collected from 4 spine surgeons who used 3 different strategies for monitoring of pedicle screw placement in multilevel lumbar degenerative disease. A decision analysis model was developed to analyze costs and outcomes of the 3 different monitoring strategies. A total of 448 surgeries performed between 2005 and 2010 were included, with 4 cases requiring repeat operation for malpositioned screws. A sample of 64 of these patients was chosen for structured interviews in which the EuroQol-5D questionnaire was used. Expected costs and quality-adjusted life years were calculated based on the incidence of repeat operation and its negative effect on quality of life and costs. Results The decision analysis model demonstrated that the O-arm monitoring strategy is significantly (p < 0.001) less costly than the strategy of postoperative CT scanning following intraoperative uniplanar fluoroscopy, which in turn is significantly (p < 0.001) less costly than neurophysiological monitoring. The differences in effectiveness of the different monitoring strategies are not significant (p = 0.92). Conclusions Use of the O-arm for confirming pedicle screw placement is the least costly and therefore most cost-effective strategy of the 3 techniques analyzed.

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P157. An Anatomical Study which Describes the Relationship of the Pedicle Center to the Mid-Lateral Pars (MLP) in the Lower Lumbar Spine as a Guide to Pedicle Screw Placement

The Spine Journal ◽

10.1016/j.spinee.2009.08.418 ◽

2009 ◽

Vol 9 (10) ◽

pp. 195S

Author(s):

Brian Su ◽

Paul Kim ◽

Thomas Cha ◽

Joseph Lee ◽

Ernest April ◽

...

Keyword(s):

Lumbar Spine ◽

Pedicle Screw ◽

Anatomical Study ◽

Screw Placement ◽

Pedicle Screw Placement ◽

Lower Lumbar Spine ◽

Lower Lumbar ◽

Relationship Of ◽

The Relationship

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Early Detection of the Internal Capsule Infarction by Intraoperative Neuromonitoring in Mesial Temporal Epilepsy Surgery

Journal of the Korean Neurological Association ◽

10.17340/jkna.2020.4.5 ◽

2020 ◽

Vol 38 (4) ◽

pp. 281-285

Author(s):

Suyeon Seo ◽

Yongdeok Lee ◽

Jae-Seung Baek ◽

Chae Young Lee

Keyword(s):

Epilepsy Surgery ◽

Action Potentials ◽

Motor Evoked Potentials ◽

Internal Capsule ◽

Neurophysiological Monitoring ◽

Muscle Action ◽

Mri Findings ◽

Temporal Epilepsy ◽

Compound Muscle Action Potentials ◽

Capsular Infarction

Intraoperative neurophysiological monitoring (INM) is underutilized during the anteromesial temporal resection (AMTR) in epilepsy surgery. Herein we report a case with intraoperative capsular infarction which was early detected by INM. Among the modalities of INM, left motor evoked potentials (MEP) showed suddenly decreased amplitude of compound muscle action potentials, after the electrocoagulation in left mesial temporal areas. Postoperative neurologic and MRI findings were well correlated to the intraoperative MEP features. We also discuss the usefulness of INM during the AMTR.

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