PubMed Research Publications:
Latest review from Isley etal, here is the most recent review article on Pedicle screw stimulation and evaluation using EMG monitoring techniques. It might be a good read to refresh the knowledge about the literature on pedicle screw tests.
Current trends in pedicle screw stimulation techniques: lumbosacral, thoracic, and cervical levels.
Abstract: Unequivocally,
pedicle screw instrumentation has evolved as a primary construct for
the treatment of both common and complex spinal disorders. However an
inevitable and potentially major complication associated with this type
of surgery is misplacement of a pedicle screw(s) which may result in
neural and vascular complications, as well as impair the biomechanical
stability of the spinal instrumentation resulting in loss of fixation.
In light of these potential surgical complications, critical reviews of
outcome data for treatment of chronic, low-back pain using pedicle screw
instrumentation concluded that "pedicle screw fixation improves
radiographically demonstrated fusion rates;" however the expense and
complication rates for such constructs are considerable in light of the
clinical benefit (Resnick et al. 2005a). Currently, neuromonitoring
using free-run and evoked (triggered) electromyography (EMG) is widely
used and advocated for safer and more accurate placement of pedicle
screws during open instrumentation procedures, and more recently,
guiding percutaneous placement (minimally invasive) where the pedicle
cannot be easily inspected visually. The latter technique, evoked or
triggered EMG when applied to pedicle screw instrumentation surgeries,
has been referred to as the pedicle screw stimulation technique. As
concluded in the Position Statement by the American Society of
Neurophysiological Monitoring (ASNM), multimodality neuromonitoring
using free-run EMG and the pedicle screw stimulation technique was
considered a practice option and not yet a standard of care (Leppanen
2005). Subsequently, the American Association of Neurological
Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on
Disorders of the Spine and Peripheral Nerves published their "Guidelines
for the Performance of Fusion Procedures for Degenerative Disease of
the Lumbar Spine" (Heary 2005, Resnick et al. 2005a, Resnick et al.
2005b). It was concluded that the "primary justification" of intraoperative neuromonitoring"...
is the perception that the safety and efficacy of pedicle screw
fixation are enhanced..." (Resnick et al. 2005b). However in summarizing
a massive (over 1000 papers taken from the National Library of
Medicine), contemporary, literature review spanning nearly a decade
(1996 to 2003), this invited panel (Resnick et al. 2005b) recognized
that the evidence-based documents contributing to the parts related to
pedicle screw fixation and neuromonitoring
were "... full of potential sources of error ..." and lacked
appropriate, randomized, prospective studies for formulating rigid
standards and guidelines. Nevertheless, current trends support the
routine use and clinical utility of these neuromonitoring
techniques. In particular free-run and triggered EMG have been well
recognized in numerous publications for improving both the accuracy and
safety of pedicle screw implantation. Currently, treatment with pedicle
screw instrumentation routinely involves all levels of the spine -
lumbosacral, thoracic, and cervical. Significant historical events,
various neuromonitoring modalities, intraoperative
alarm criteria, clinical efficacy, current trends, and caveats related
to pedicle screw stimulation along the entire vertebral column will be
reviewed.
- PMID: Neurodiagn J. 2012 Jun;52(2):100-75.
- 22808751
- [PubMed - in process]