Application of a Novel Attachable Magnetic Nerve Stimulating Probe in Intraoperative Lumbar Pedicle Screw Placement: A Porcine Model Study

Tae Sik Goh,Hyun-Keun Kwon,Eui-Suk Sung,Byung-Joo Lee,Se Bin Jun,Sung-Chan Shin,Jung Sub Lee

doi:10.3390/app11177801

Tae Sik Goh, Hyun-Keun Kwon + Show 5 more

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https://doi.org/10.3390/app11177801

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Abstract

Pedicle screw instrumentation is a fundamental technique in lumbar spine surgery. However, several complications could occur when placing a pedicle screw, the most serious being damage to the neural structures. We developed an attachable magnetic nerve stimulating probe used for triggered electromyography (t-EMG) to avoid these. This study aimed to investigate the efficacy of this probe for intraoperative neuromonitoring (ION) during lumbar pedicle screw placement in a porcine model. Forty pedicle screws were inserted bilaterally into the pedicles of the fourth and fifth lumbar vertebrae of five pigs; 20 were inserted typically into the pedicle without nerve damage (Group A), and the other 20 were inserted through the broken medial wall of the pedicle to permit contact with the neural structures (Group B). We measured the triggered threshold for pedicle screw placement through the conventional nerve probe and our newly developed magnetic probe. There was no significant difference in the triggered threshold between the two instruments (p = 0.828). Our newly developed magnetic stimulating probe can be attached to a screwdriver, thus preventing real-time screw malpositioning and making it practical and equally safe. This probe could become indispensable in revision spine surgeries with severe adhesions or endoscopic spine surgeries.

Highlights

Pedicle screws are essential for posterior fusion operations in lumbar degenerative diseases such as spinal stenosis and lumbar degenerative kyphosis [1,2]
As safety is the topmost priority for both surgeons and patients, various surveillance devices, including image guidance systems and electromyographic tests for use during the actual surgery, are increasing in demand, and the interest in research in the field of spine surgery is on the rise
There was no significant difference between the two groups from the experiment on Group B assuming neural injury during lumbar pedicle screw placement (p = 0.816, Figure 6)

Summary

Introduction

Pedicle screws are essential for posterior fusion operations in lumbar degenerative diseases such as spinal stenosis and lumbar degenerative kyphosis [1,2]. Care should be taken while inserting the pedicle screw since damage to the spinal cord or nerve root is most likely irreversible and could be fatal. As safety is the topmost priority for both surgeons and patients, various surveillance devices, including image guidance systems and electromyographic tests for use during the actual surgery, are increasing in demand, and the interest in research in the field of spine surgery is on the rise. The most widely used surveillance devices during spinal surgery are image guidance systems, namely the dual-planar 2-D fluoroscopy and intraoperative 3-D scan [7,8]. The disadvantage of these imaging devices is that they do not offer real-time and direct monitoring of the procedure for nerve damage while the pedicle screws are being inserted. In order to minimize the chances of complications and produce the optimal outcome for the patient, intraoperative fluoroscopy alone is inadequate and intraoperative neurophysiologic monitoring (ION) should be performed routinely

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