Abstract

Introduction Despite the improvement in the detection of misplaced thoracic pedicle screws in the last years, there is still a percentage of malpositioned thoracic screws that are not detected by conventional neurophysiological monitoring techniques. Methods We have set a neurophysiological protocol during the scoliosis surgery: simple and pulse-train stimulation at the pedicle track and over the screws. We have included the level L1 because the spinal cord typically extends caudally through that level. We assume a malposition in pedicle holes with thresholds below 9 mA at the simple stimulation and below 15 mA at the pulse-train stimulation. In cases with borderline stimulation thresholds, final placement of the screw was decided by the surgeon. Results Of 436 monitored screws, the surgeon modified 15 pedicle tracks due to low threshold intraoperatively. After the surgery, none of the patients showed neurological symptoms. In the CT-scan, 5 of all analyzed screws showed mediocaudal malposition and the rest of screws were well placed. Conclusion Pulse-train stimulation of the pedicle tracks and of the screws allow us to increase the sensibility for the detection of malpositioned thoracic screws. The stimulation of the pedicle track is a valuable tool to increase the safety and decrease the possibility of complications associated with the thoracic screws malpositioning.

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