Transabdominal Motor Action Potential Monitoring of Pedicle Screw Placement During Minimally Invasive Spinal Procedures: A Case Study.

Anisha Narayan,William Taylor,Sandy Taylor

doi:10.7759/cureus.9497

Abstract

Precise pedicle screw placement is a critical skill during minimally invasive spinal surgeries but can pose various challenges. Techniques such as electromyography (EMG) have been traditionally utilized for this purpose but have several shortcomings. Transabdominal motor action potential (TaMAP) has been examined as a possible effective neuromonitoring alternative and is hypothesized to provide important data on symptomatic malpositioned pedicle screws. The current study seeks to determine whether TaMAP may be an advantageous technique in the neuromonitoring of percutaneous pedicle screw placement during minimally invasive spinal procedures. The methodology involved recording TaMAP signals at the outset and the conclusion of spinal surgical procedures in human participants, for which comparisons were made of pre- and post-operative data. Results revealed that TaMAP signals remained stable during accurate pedicle screw placement and degraded during a case of inaccurate placement, for which initial misplaced hardware altered the depolarization threshold and resulted in substantial signal alteration. These results suggest that TaMAP, which is stable, repeatable, and reflects real-time information, can potentially be used as a reliable and more precise indication of accuracy in pedicle screw placement during spinal surgeries. This is the first TaMAP study conducted in human participants.

Highlights

IntroductionMinimally invasive methods have been shown to have advantages over open surgical techniques, resulting in decreased muscle damage and blood loss, determination of the pedicle screw trajectory may be challenging due to the difficulty in visualizing it, leading to nerve injuries [2]
CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any Precise placement of percutaneous pedicle screws is a critical technique for minimally invasive spinal procedures [1]
The current study suggests a novel method to improve neuromonitoring during pedicle screw placement using the transabdominal motor action potential (TaMAP) technique

Summary

Introduction

Minimally invasive methods have been shown to have advantages over open surgical techniques, resulting in decreased muscle damage and blood loss, determination of the pedicle screw trajectory may be challenging due to the difficulty in visualizing it, leading to nerve injuries [2]. The current study suggests a novel method to improve neuromonitoring during pedicle screw placement using the transabdominal motor action potential (TaMAP) technique. This neurophysiological tool can assess the functional integrity of individual nerve roots in real-time and may help surgeons recognize impending neural injuries that cannot be detected by traditionally used techniques such as electromyography (EMG) [4].

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Discussion

Conclusion