Electrical conductivity measurement: a new technique to detect iatrogenic initial pedicle perforation
European Spine Journal - 2007
Tóm tắt
Pedicle screw fixation has achieved significant popularity amongst spinal surgeons for both single and multi-level spinal fusion. Misplacement and pedicle cortical violation occurs in over 20% of screw placement and can result in potential complications such as dysthesia, paraparesis or paraplegia. There have been many advances in techniques available for navigating through the pedicle; however, these techniques are not without drawbacks. A new electrical conductivity-measuring device, previously evaluated on the porcine model to detect the pedicle violation, was evaluated amongst nine European Hospitals to be used in conjunction with the methods currently used in that centre. This new device is based on two original principles; the device is integrated in the drilling or screwing tool. The technology allows real-time detection of perforation through two independent parameters, impedance variation and evoked muscle contractions. Data was collected twofold. Initially, the surgeon was given the device and a comparison was made between the devices ability to detect a breech and the surgeon’s ability to detect one using his traditional methods of pedicle preparation. In the second module of the study, the surgeon was limited to using the electrical conductivity detection device as their sole guide to detect pedicle breaches. A comparison was made between the detection ability of the device and the other detection possibilities. Post-operative fine cut CT scanning was used to detect the pedicle breaches. Overall, the 11 trial surgeons performed a total of 521 pedicle drillings on 97 patients. Initially there were 147 drillings with 23 breaches detected. The detection rate of these breaches were 22/23 for the device compared to 10/23 by the surgeon. Over both parts of the study 64 breaches (12.3%) were confirmed on post-operative CT imaging. The electrical conductivity detection device detected 63 of the 64 breaches (98.4%). There was one false negative and four false positives. This gives the device an overall sensitivity of 98% and specificity of 99% for detecting a pedicle breach. The negative predictive value was 99.8%, with a positive predictive value of 94%. No adverse event was noted with the use of the electrical conductivity device. Electrical conductivity monitoring may provide a simple, safe and sensitive method of detecting pedicle breech during routine perforation of the pedicle, in the course of pedicle screw placement.
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Tài liệu tham khảo
Acikbas SC, Arslan FY, Turner MR (2003) The effect of transarticular screw misplacement on late spinal stability. Acta Neurochir 145:949–954
Amiot L, Lang K, Zippel H (1998) Comparison accuracy between conventional and computer-assisted pedicle screw installation. J Bone Joint Surg [Br] 80:240
Beatty RM, McGuire P, Moroney JM (1995) Continuous intraoperative electromyographic recording during spinal surgery. J Neurosurg 82:401–405
Bolger C, Carozzo C, Roger T, McEvoy L, Nagaria J, Vanacker G, Bourlion M (2005) A preliminary study of reliability of impedance measurement to detect iatrogenic initial pedicle perforation (in the porcine model) Eur Spine J 15(3):316–320
Bolger C, Wigfield C (2000) Image-guided surgery: applications to the cervical and thoracic spine and a review of the first 120 procedures. J Neurosurg 92:175–180
Darden BV, Wood KE, Hatley MK, Owen JH, Kostuik J (1996) Evaluation of pedicle screw insertion monitored by intraoperative evoked electromyography. J Spinal Disord 9:8–16
Davane SH, Myers DL (1992) Complications of lumbar spine fusion with transpedicular instrumentation. Spine 17:362–367
Esses SI, Sachs BL, Dreyzin V (1993) Complications associated with technique of pedicle screw fixation. Spine 18:2231–2239
Foley K, Smith M (1996) Image-guided spine surgery. Neurosurg Clin N Am 7:171–186
Foley KT, Simon DA, Rampersaud YR (2001) Virtual fluoroscopy: computer-assisted fluoroscopic navigation. Spine 26:347–351
Gundanna M, Eskenazi M, Bendo J, Spivak J, Moskovich R (2003) Somatosensory evoked potential monitoring of lumbar pedicle screw placement for in situ posterior spinal fusion. Spine J 3:370–376
Herdmann J, Deletis V, Edmonds HL, Morota N (1996) Spinal cord and nerve root monitoring in spine surgery and related procedures. Spine 21:870–877
Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD (2004) Free hand pedicle screw placement in the thoracic spine: is it safe? Spine 29:333–342
Laine T (2005) Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutaive patients. Eur Spine J 9:235–240
Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D (2000) Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J 9:235–240
Lubicky J, Spadaro J, Yuan H, Fredrickson B, Henderson N (1989) Variability of somatosensory cortical evoked potential monitoring during spinal surgery. Spine 14:790–798
Nohara Y, Taneichi H, Ueyama K, Kawahara N, Shiba K, Tokuhashi Y, Tani T, Nakahara S, Iida T (2004) Nationwide survey on complications of spine surgery in Japan. J Orthop Sci 9:424–433
Rampersaud YR, Foley KT, Shen AC et al (2000) Radiation exposure to the spine surgeon during fluroscopically assissted pedicle insertion. Spine 25:2637–2645
Rampersaud YR, Pik JH, Salonen D, Farooq S (2005) Clinical accuracy of fluoroscopic computer-assisted pedicle screw fixation: a CT analysis. Spine 30:E183–E190
Rappaport M, Lenord J, Portillo S (1992) Effect of anaesthesia and stimulus intensity on posterior tibial nerve somatosensory evoked potentials. Clin Electroencephalogr 23:24–30
Roy-Camille R, Saillant G, Mazel C (1986) Internal fixation of the lumbar spine with pedicle screw plating. Clin Orthop 203:7–17
Sagi H, Manos R, Ordway NR, Connolly PJ (2003) Electromagnetic field-based image-guided surgery part one: results of a cadaveric study evaluating lumbar pedicle screw placement. Spine 28:2013–2018
Shi YB, Binette M, Martin WH, Pearson JM, Hart RA (2003) Electrical stimulation for intraoperative evaluation of thoracic pedicle screw placement. Spine 28:595–601
Toleikis JR (2002) Neurophysiological monitoring during pedicle screw placement. In: Deletis V, Shils J (eds) Neurophysiology in neurosurgery. Academic, New York, pp 231–234
Vaccaro AR, Rizzolo SJ, Balderston RA, Allardyce TJ, Garfin SR, Dolinskas C, An HS (1995) Placement of pedicle screws in the thoracic spine. Part II: an anatomical and radiographic assessment. J Bone Joint Surg Am 77:1200–1206