INTRAOPERATIVE EVOKED EMG MONITORING IN AN ANIMAL-MODEL - A NEW TECHNIQUE FOR EVALUATING PEDICLE SCREW PLACEMENT

被引：86
作者：
CALANCIE, B
LEBWOHL, N
MADSEN, P
KLOSE, KJ
机构：
[1] Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL
[2] Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine, Miami, FL
来源：
SPINE | 1992年 / 17卷 / 10期
关键词：
Intraoperative monitoring neurologic deficit; Pedicle screws; Pigs; Spinal instrumentation;
D O I：
10.1097/00007632-199210000-00017
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
An electric drill was used to introduce holes in the L4 through L7 pedicles in pigs. Constant-voltage stimulating pulses (5.5 V, stimulus rate = 3/sec) were delivered through a ball-tipped probe used to palpate the walls of each pedicle, and observation was made of electromyogram (EMG) evoked from hind limb muscles. Screws were placed in each pedicle hole, and evaluated for absolute voltage necessary to evoke EMG (threshold). At the conclusion of each experiment, screw positions were ascertained by removal and dissection of the lumbosacral spine. Approximately 50% of screw placements resulted in defects of the pedicle. In each of these cases, 5.5 V stimuli delivered through the probe evoked EMG from muscles innervated by adjacent motor axons. Conversely, for those cases where the pedicle was intact, significantly higher voltages were needed to evoke EMG. The authors believe that this is a promising intraoperative technique to simply and reliably identify mispositioned screws, thereby minimizing neurologic complications.
引用
收藏
页码：1229 / 1235
页数：7
相关论文
共 17 条
  • [1] Aebi M., Etter C., Kehl T., Thalgott J., Stabilization of the lower thoracic and lumbar spine with the internal spinal skeletal fixation system: Indications, techniques, and first re-sults of treatment, Spine, 12, pp. 546-551, (1987)
  • [2] Brown R.H., Nash C.L., Berilla J.A., Amaddio M.D., Cortical evoked potential monitoring: A system for intraoperative monitoring of spinal cord function, Spine, 9, pp. 256-261, (1984)
  • [3] Dinner D.S., Luders H., Lesser R.P., Et al., Intraoperative spinal somatosensory evoked potential monitoring, J Neurosurg, 65, pp. 807-814, (1986)
  • [4] Gertzbein S.D., Robbins S.E., Accuracy of pedicular screw placement in vivo, Spine, 15, pp. 11-14, (1990)
  • [5] Grundy B.L., Intraoperative monitoring of sensory-evoked potentials, Anesthesiology, 58, pp. 72-87, (1983)
  • [6] Horowitch A., Peek R.D., Thomas J., Et al., The Wiltse pedicle screw fixation system: Early clinical results, Spine, 14, pp. 461-467, (1989)
  • [7] Krag M.H., Fredrickson B.E., Yuan H.A., Spinal Instrumenta-Tion. The Lumbar Spine, pp. 916-955, (1990)
  • [8] Krag M.H., Van Hal M.E., Beynnon B.D., Placement of transpedicular vertebral screws close to anterior vertebral cortex: Description of methods, Spine, 14, pp. 879-883, (1989)
  • [9] Matsuzaki H., Tokuhashi Y., Matsumoto F., Et al., Problems and solutions of pedicle screw plate fixation of lumbar spine, Spine, 15, pp. 1159-1165, (1990)
  • [10] Moran J.M., Berg W.S., Berry J.L., Geiger J.M., Steffee A.D., Transpedicular screw fixation, J Orthop Res, 7, pp. 107-114, (1989)
12