scholarly journals Retrospective Study of Nerve Injury and Pedicle Screw Breach after Pedicle Screw Fixation with Intraoperative Triggered Electromyography Monitoring

2021 ◽  
Author(s):  
Nattawut Niljianskul ◽  
I-sorn Phoominaonin
Keyword(s):  
Risk Factors ◽  
Pedicle Screw ◽  
Nerve Injury ◽  
Sensitivity And Specificity ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Degenerative Disease ◽  
P Value ◽  
Stimulation Threshold ◽  
Factors Associated

Objective: To evaluate the incidence of nerve injury and pedicle breach after pedicle screw fixation (PSF) with intraoperative triggered electromyography (tEMG) monitoring.Material and Methods: All patients who underwent PSF with intraoperative tEMG at Vajira Hospital between October 2018 and March 2020 were included. Patients with dysmorphic pedicle features, preoperative infection, or incomplete follow-up data were excluded. PSF was done with intraoperative tEMG. The stimulation threshold was recorded. Stimulation threshold <7 mA was not allowed to proceed with the procedure and required reposition of pedicle screw immediately. Post-operative nerve injury was evaluated by physical examination and computer tomography of the spine was done to detect any pedicle breaches. The sensitivity and specificity of intraoperative tEMG to detect pedicle breach were calculated. The risk factors associated with pedicle breach were analyzed.Results: The records of thirty-six patients with 278 pedicle screws were analyzed. No post-operative nerve injuries were found. The incidence of pedicle breach was 2.2%. The sensitivity and specificity were 83.0% and 91.0%, respectively. The risk factors associated with pedicle breach were degenerative disease and tumor(s) (odds ratio (OR) 3.05, 95% confidence interval (CI) 1.11-8.41, p-value=0.030) and stimulation threshold 7-10 mA (OR 0.02, 95% CI 0.00-0.19, p-value< 0.001). Conclusion: PSF with intraoperative tEMG was safe for neural integrity. Intraoperative tEMG had the ability to detect pedicle breaches with fair sensitivity and high specificity. Patients with degenerative disease, tumors, or stimulation threshold less than 11 mA had a higher risk of pedicle breach.

scholarly journals Risk Factors of Unsatisfactory Robot-Assisted Pedicle Screw Placement: A Case-Control Study

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 839-844
Author(s):  
Qi Zhang ◽  
Ming-Xing Fan ◽  
Xiao-Guang Han ◽  
Ya-Jun Liu ◽  
Da He ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pedicle Screw ◽  
Severe Obesity ◽  
Screw Fixation ◽  
Pedicle Screw Fixation ◽  
Screw Placement ◽  
Pedicle Screw Placement ◽  
Robot Assisted ◽  
Potential Risk Factors ◽  
Screw Position

Objective: To identify potential risk factors of unsatisfactory screw position during robot-assisted pedicle screw fixation.Methods: A retrospective analysis of robot-assisted pedicle screw fixation performed in Beijing Jishuitan Hospital from March 2018 to March 2019 was conducted. Research data was collected from the medical record and imaging systems. Univariate tests were performed on the potential risk factors (patient’s characteristics and surgical factors) of unsatisfactory screw position during robot-assisted pedicle screw fixation. For statistically significant variables in univariate tests, a logistic regression test was used to identify independent risk factors for unsatisfactory screw position.Results: A total of 780 pedicle screws placed in 163 robot-assisted surgeries were analyzed. The rate of perfect screw positions was 93.08%, and the unsatisfactory rate was 6.92%. In patients with severe obesity (body mass index ≥ 30 kg/m<sup>2</sup>) (odds ratio [OR], 2.459; 95% confidence interval [CI], 1.199–5.044; p = 0.014), osteoporosis (T ≤ -2.5) (OR, 1.857; 95% CI, 1.046–3.295; p = 0.034), and the segments 3 levels away from the tracker (OR, 2.216; 95% CI, 1.119–4.387; p = 0.022), robot-assisted pedicle screw placement has a higher risk of screw malposition.Conclusion: During robot-assisted pedicle screw placement for patients with severe obesity, osteoporosis, and segments 3 levels away from the tracker, vigilance should be maintained during surgery to avoid postoperative complications due to unsatisfactory screw position.

scholarly journals Thoracic spondylotic myelopathy presumably caused by diffuse idiopathic skeletal hyperostosis in a patient who underwent decompression and percutaneous pedicle screw fixation

2021 ◽  
Vol 9 ◽  
pp. 2050313X2098779
Author(s):  
Shota Miyoshi ◽  
Tadao Morino ◽  
Haruhiko Takeda ◽  
Hiroshi Nakata ◽  
Masayuki Hino ◽  
...  
Keyword(s):  
Pedicle Screw ◽  
Screw Fixation ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Pedicle Screw Fixation ◽  
Vertebral Bone ◽  
Bone Bridge ◽  
Percutaneous Pedicle Screw ◽  
Bilateral Lower Limb ◽  
Upper Thoracic ◽  
Percutaneous Pedicle Screw Fixation

A 74-year-old man developed bilateral lower limb spastic paresis. He was diagnosed with thoracic spondylotic myelopathy presumably caused by mechanical stress that was generated in the intervertebral space (T1-T2) between a vertebral bone bridge (C5-T1) due to diffuse idiopathic skeletal hyperostosis after anterior fixation of the lower cervical spine and a vertebral bone bridge (T2-T7) due to diffuse idiopathic skeletal hyperostosis in the upper thoracic spine. Treatment included posterior decompression (T1-T2 laminectomy) and percutaneous pedicle screw fixation at the C7-T4 level. Six months after surgery, the patient could walk with a cane, and the vertebral bodies T1-T2 were bridged without bone grafting. For thoracic spondylotic myelopathy associated with diffuse idiopathic skeletal hyperostosis, decompression and percutaneous pedicle screw fixation are effective therapies.

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