Diathermy Stimulation to Avoid Nerve Injuries during Trans-pedicular Screw Placement in Dorso-lumbar Spine
Keywords:
Diathermy, Trans-pedicular screws, Dorso-lumbar spine, Nerve injuryAbstract
Objective: To demonstrate the utility of diathermy in avoiding nerve injuries due to misplacement of trans-pedicular screws (TPSs) during Dorso-lumbar spinal fusion.
Study Design: Retrospective study
Place and Duration of the Study: Department of Neurosurgery, Lahore General Hospital, Lahore, from Oct. – 2007 to Oct. 2012.
Materials and Methods: In this retrospective study, diathermy was used to assess whether a screw deviated from the pedicle by observing synchronous leg movements caused by intermittently touching a diathermy to the pedi-cular instrument. Diathermy was performed in 159 cases in which 561 pedicle screws had been placed.
Results: Leg movements were observed in 36 cases and the sensitivity of diathermy was 82.7%, the specificity of 98.6%. No neurological complications associated with the placement of pedicular screws were observed after adding diathermy stimulation to the conventional methods.
Conclusion: Diathermy may be helpful to avoid nerve injuries during transpedicular screw placement.
References
1. West JL, Bradford DS, Ogilvie JW et al. results of spinal orthodesis with pedicle screw – plate fixation. J Bone Joint Surg Am 73:1179-1184, 1991.
2. Bosnjak R, Dolenc VV: Electrical thresholds for bio-mechanical response in ankle to direct stimulation of spinal roots L4, L5, and S1. Implications for intraopera-tive pedicle screw testing. Spine 2000; 25: 703-708.
3. Bose B, Wiezbowski LR, Sestokas AK: Neurophysio-logic monitoring of spinal nerve root function during instrumental posterior lumbar spine surgery. Spine 2002; 27: 1444-1450.
4. Boachie – Adjei O, Girardi FP, Bansal M, and Rwalins BA: Safety and efficacy of pedicle screw placement for adult spinal deformity with pedicle probing convent-ional anatomic technique. J Spinal Disord 2000; 13: 496-500.
5. Calancie B, Madsen P, Lebwohl N: Stimulus – evoked EMG monitoring during transpedicular lumbosacral spine instrumentation. Initial clinical results. Spine 1994; 19: 2780-2786.
6. Castro WH, Halm H, Jerosch J et al., Accuracy of pedi-cle screw placement in lumbar vertebrae. Spine 1996; 21: 1320-1324.
7. Darden BV 2nd, Owen JH, Hatley MK, Kostuik J, Tooke SM.A comparison of impedance and electro-myogram measurements in detecting the presence of pedicle wall breakthrough.Spine. 1998 Jan 15; 23 (2): 256-62.
8. Davne SH, Myers DL.Complications of lumbar spinal fusion with transpedicular instrumentation.Spine. 1992 Jun; 17 (6 Suppl): S184-9.
9. Matsuzaki H, Tokuhashi Y, Matsumoto F et al: prob-lems and solutions of pedicle screw plate fixation of lumbar spine. Spine 1990; 15: 1159-1165.
10. Faraj AA, Webb JK.Early complications of spinal pedi-cle screw. Eur Spine J. 1997; 6 (5): 324-6.
11. Gundanna MI, Eskenazi M, Bendo J, Spivak J, Mosko-vich R. Somatosensory Evoked Potential Monitoring of Lumbar Pedicle Screw Placement. The Spine Journal. Sep-Oct 2003; 3 (5): 370-6.
12. Glassman S.D., Diamar J.R., Puno R.M., Johnson J.R., Shields C.B., Liden R.D. A prospective analysis of intraoperative electromyographic monitoring of pedicle screw placement with computed tomographic scan con-firmation. Spine 1995; 20: 1375-1379.
13. Fukushi J, Ueda T, Shiba K, Shirasawa K, Ota H, Mori E, et al: Neurological complications associated pedicle screw displacement.
14. Holland, Neil R. et al.Higher Electrical Stimulus Inten-sities Are Required to Activate Chronically Compres-sed Nerve Roots: Implications for Intraoperative Elec-tromyographic Pedicle Screw Testing Spine: 15 January 1998; Volume 23, Issue 2: p. 224–227.
15. Jutte PC et al. Complications of pedicle screws in lum-
bar and lumbosacral fusions in 105 consecutive primary operation European Spine Journal, December 2002; Volume 11, Issue 6: pp. 594-598.
16. Laine T et al.Accuracy of pedicle screw insertion: A prospective CT study in 30 low back patients. European Spine Journal, December 1997; Volume 6, Issue 6: pp. 402-40.
17. Lenke LG, Padberg MS, Russo MS, Bridwell KH, and Gelb DE: Triggered electro-myographic threshold for accuracy of pedicle screw placement. An animal model and clinical correlation. Spine 1995; 20: 1585-1591.
18. Lonsteine JE, Denis F, Perra JH et al: Complications associated with pedicle screws Bone Joint Surg Am 1999; 81: 1519-1528.
19. Maguire J, Wallace S, Madiga R et al: Evaluation of the intrapedicular screw position using intra-operative evo-ked electromyography. Spine 1995; 20: 1068-1074.
20. Esses SI, Sachs BL, Dreyzin V. Complications associ-ated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine. 1993 Nov; 18 (15): 2231-8; discussion 2238-9.
21. Mizuno K, Nakai O, Kurosa Y et al. complications of pedicle screw instrumentation in lumbar spine surgery. Higasinihonn Rinseikaishi 1996; 8: 174- 176.
22. Murata M, Shingu H, Kimura K, Nasu Y et al. compli-cation of pedicle screws fixation of spinal disorder. Rinnhouseikeigeka 1997; 32: 765-772.
23. Owen JH, Kostuik JP, Gornet M et al. The use of me-chanically elicited electro-myograms to protect nerve roots during surgery for spinal degeneration. Spine 1994; 19: 1704-1710.
24. Owen JH, Padberg AM, Holland – spahr L et al. Clini-cal correlations between degenerative spine disease and Dermatomal somatosensory evoked potentials in hum-ans. Spine 1991; 16: s201-s205.
25. Saito M, Kohno H, Okada S et al. complications asso-ciated with pedicle screw fixation using cotrel-dubous-set instrument. Kotsu – kansetsu – jintal 1998; 11: 299-304.
26. Yamazaki T, Imai T, Akune T et al. A technique to insert pedicle screw correctly using electric stimulation. Orthopedic Surgery 1996; 47: 1753-1756.
27. Uchida T, Kumano k: Over 10 year follow up clinical outcome of pedicle screw fixation for degenerative lumbar disorders. Kansetsugeka 2001; 20: 22-32.
28. Weinstein JN, Spratt KF, Spengler D et al. spinal pedi-cle fixation: reliability and validity of roentgenograms- based assessment and surgical factors on successful screw placement. Spine 1988; 13: 1012-1018.
29. Blumenthal S, Gill K: Complications of the Wiltse Pe-dicle Screw Fixation System. Spine 1993; 18: 1867-1871.
30. Toleikis JR, Skelly JP, Carlvin AO et al. The usefulness of electrical stimulation for assessing pedicle screw pla-cements. J Spinal Discord1 2000; 3: 283-289.
2. Bosnjak R, Dolenc VV: Electrical thresholds for bio-mechanical response in ankle to direct stimulation of spinal roots L4, L5, and S1. Implications for intraopera-tive pedicle screw testing. Spine 2000; 25: 703-708.
3. Bose B, Wiezbowski LR, Sestokas AK: Neurophysio-logic monitoring of spinal nerve root function during instrumental posterior lumbar spine surgery. Spine 2002; 27: 1444-1450.
4. Boachie – Adjei O, Girardi FP, Bansal M, and Rwalins BA: Safety and efficacy of pedicle screw placement for adult spinal deformity with pedicle probing convent-ional anatomic technique. J Spinal Disord 2000; 13: 496-500.
5. Calancie B, Madsen P, Lebwohl N: Stimulus – evoked EMG monitoring during transpedicular lumbosacral spine instrumentation. Initial clinical results. Spine 1994; 19: 2780-2786.
6. Castro WH, Halm H, Jerosch J et al., Accuracy of pedi-cle screw placement in lumbar vertebrae. Spine 1996; 21: 1320-1324.
7. Darden BV 2nd, Owen JH, Hatley MK, Kostuik J, Tooke SM.A comparison of impedance and electro-myogram measurements in detecting the presence of pedicle wall breakthrough.Spine. 1998 Jan 15; 23 (2): 256-62.
8. Davne SH, Myers DL.Complications of lumbar spinal fusion with transpedicular instrumentation.Spine. 1992 Jun; 17 (6 Suppl): S184-9.
9. Matsuzaki H, Tokuhashi Y, Matsumoto F et al: prob-lems and solutions of pedicle screw plate fixation of lumbar spine. Spine 1990; 15: 1159-1165.
10. Faraj AA, Webb JK.Early complications of spinal pedi-cle screw. Eur Spine J. 1997; 6 (5): 324-6.
11. Gundanna MI, Eskenazi M, Bendo J, Spivak J, Mosko-vich R. Somatosensory Evoked Potential Monitoring of Lumbar Pedicle Screw Placement. The Spine Journal. Sep-Oct 2003; 3 (5): 370-6.
12. Glassman S.D., Diamar J.R., Puno R.M., Johnson J.R., Shields C.B., Liden R.D. A prospective analysis of intraoperative electromyographic monitoring of pedicle screw placement with computed tomographic scan con-firmation. Spine 1995; 20: 1375-1379.
13. Fukushi J, Ueda T, Shiba K, Shirasawa K, Ota H, Mori E, et al: Neurological complications associated pedicle screw displacement.
14. Holland, Neil R. et al.Higher Electrical Stimulus Inten-sities Are Required to Activate Chronically Compres-sed Nerve Roots: Implications for Intraoperative Elec-tromyographic Pedicle Screw Testing Spine: 15 January 1998; Volume 23, Issue 2: p. 224–227.
15. Jutte PC et al. Complications of pedicle screws in lum-
bar and lumbosacral fusions in 105 consecutive primary operation European Spine Journal, December 2002; Volume 11, Issue 6: pp. 594-598.
16. Laine T et al.Accuracy of pedicle screw insertion: A prospective CT study in 30 low back patients. European Spine Journal, December 1997; Volume 6, Issue 6: pp. 402-40.
17. Lenke LG, Padberg MS, Russo MS, Bridwell KH, and Gelb DE: Triggered electro-myographic threshold for accuracy of pedicle screw placement. An animal model and clinical correlation. Spine 1995; 20: 1585-1591.
18. Lonsteine JE, Denis F, Perra JH et al: Complications associated with pedicle screws Bone Joint Surg Am 1999; 81: 1519-1528.
19. Maguire J, Wallace S, Madiga R et al: Evaluation of the intrapedicular screw position using intra-operative evo-ked electromyography. Spine 1995; 20: 1068-1074.
20. Esses SI, Sachs BL, Dreyzin V. Complications associ-ated with the technique of pedicle screw fixation. A selected survey of ABS members. Spine. 1993 Nov; 18 (15): 2231-8; discussion 2238-9.
21. Mizuno K, Nakai O, Kurosa Y et al. complications of pedicle screw instrumentation in lumbar spine surgery. Higasinihonn Rinseikaishi 1996; 8: 174- 176.
22. Murata M, Shingu H, Kimura K, Nasu Y et al. compli-cation of pedicle screws fixation of spinal disorder. Rinnhouseikeigeka 1997; 32: 765-772.
23. Owen JH, Kostuik JP, Gornet M et al. The use of me-chanically elicited electro-myograms to protect nerve roots during surgery for spinal degeneration. Spine 1994; 19: 1704-1710.
24. Owen JH, Padberg AM, Holland – spahr L et al. Clini-cal correlations between degenerative spine disease and Dermatomal somatosensory evoked potentials in hum-ans. Spine 1991; 16: s201-s205.
25. Saito M, Kohno H, Okada S et al. complications asso-ciated with pedicle screw fixation using cotrel-dubous-set instrument. Kotsu – kansetsu – jintal 1998; 11: 299-304.
26. Yamazaki T, Imai T, Akune T et al. A technique to insert pedicle screw correctly using electric stimulation. Orthopedic Surgery 1996; 47: 1753-1756.
27. Uchida T, Kumano k: Over 10 year follow up clinical outcome of pedicle screw fixation for degenerative lumbar disorders. Kansetsugeka 2001; 20: 22-32.
28. Weinstein JN, Spratt KF, Spengler D et al. spinal pedi-cle fixation: reliability and validity of roentgenograms- based assessment and surgical factors on successful screw placement. Spine 1988; 13: 1012-1018.
29. Blumenthal S, Gill K: Complications of the Wiltse Pe-dicle Screw Fixation System. Spine 1993; 18: 1867-1871.
30. Toleikis JR, Skelly JP, Carlvin AO et al. The usefulness of electrical stimulation for assessing pedicle screw pla-cements. J Spinal Discord1 2000; 3: 283-289.
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