Wednesday, September 26, 2018 1:00 PM – 2:00 PM Navigation and Intraoperative Monitoring: 47. The utility of intraoperative electromyography and computer-assisted navigation for lumbar pedicle screw placement

Abstract

BACKGROUND CONTEXT Suboptimal pedicle screw placement may cause neurological complications following posterolateral lumbar fusions (PLF). To decrease the risk of these complications, computer-assisted navigation (CAN) and intraoperative neuromonitoring such as electromyography (EMG) are often used during PLF to ensure safe pedicle screw placement. While CAN and EMG can improve the safety of pedicle screw placement, their routine use in PLF remains controversial. No studies have directly compared the risk of neurological complications following pedicle screw placement in PLF with and without CAN or EMG. PURPOSE Evaluate the risk of neurological injuries and risk of reoperation for pedicle screw revision/removal in patients that had PLF with and without computer-assisted navigation and/or intraoperative electromyography. STUDY DESIGN/SETTING Retrospective database study. PATIENT SAMPLE Patients undergoing posterolateral lumbar fusion. OUTCOME MEASURES Neurological injuries and risk of reoperation for pedicle screw revision/removal. METHODS Retrospective longitudinal analyses were performed using the MarketScan databases from 2007 to 2014. Patients undergoing PLF surgery with and without CAN and/or EMG for degenerative lumbar disorders were identified via ICD-9-CM and CPT codes. Exclusion criteria were: age RESULTS From 2007 to 2014, 10,246 patients underwent PLFs (age 60±12 years, 58% female). CAN only was used in 5.5% of patients, EMG only in 20% and CAN and EMG in 0.87% of patients. Overall, CAN only use increased from 2.7% in 2007 to 8.72% in 2014 (p CONCLUSIONS In this retrospective review of national administrative data, we found a steady increase in the use of CAN for PLFs from 2007 to 2014. The risk of neurological complications following primary PLFs is low and the routine use of CAN and/or EMG may not decrease this risk. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.