Department of Pediatric Orthopaedics, Arnold Palmer Hospital for Children, Orlando, FL, USA.
Spine (Phila Pa 1976). 2010 Jan 15;35(2):E43-8. doi: 10.1097/BRS.0b013e3181b3f467.
This is a retrospective analysis of 30 pediatric deformity surgeries.
The purpose of this study was to evaluate the accuracy of neuromonitoring in comparison to postoperative computed tomography scans for pedicle screw position.
Triggered electromyography potentials in aiding the placement of lumbar pedicle screws are considered useful; however, this method is less accepted in thoracic screw placement.
Thirty pediatric deformity surgeries were reviewed. All screws were placed using fluoroscopic assistance. Electromyography data were obtained on all screws. Every patient underwent postoperative computed tomography scanning. Computed tomography scans were assessed by all authors, and each screw was classified. Sensitivity, specificity, negative predictive value, and likelihood ratios were determined for the cut-off value of an electromyography > or =6 mA.
A total of 329 screws were reviewed. No complications occurred. An overall accuracy of 93% was obtained. No retained screw had greater than 2 mm medial pedicle wall breach. Nine screws were removed intraoperatively due to medial breach. The mean electromyography potential for all classes of screws was not statistically different (P > 0.1). The negative predictive value of the test was 0.92 in the thoracic spine and 0.93 in the lumbar spine. The negative likelihood ratios were 0.96 and 0.35 for the thoracic and lumbar spines respectively, and the positive likelihood ratio was 1.4 for the thoracic spine and 12.5 for the lumbar spine.
Thoracic and lumbar pedicle screws are safe surgical options in the treatment of pediatric scoliosis. Comparison of electromyography potentials and postoperative computed tomography scans showed no statistically significant difference for all classes of screws. The likelihood ratio for electromyography testing was more clinically significant in the lumbar spine. A triggered electromyography value greater than or equal to 6 mA has a high likelihood of that screw being in the "safe zone." However, there is no true electromyography cut-off value that guarantees accurate placement and avoidance of neurologic injury.
这是一项对 30 例儿科畸形手术的回顾性分析。
本研究旨在评估神经监测与术后 CT 扫描在椎弓根螺钉位置方面的准确性。
在辅助放置腰椎椎弓根螺钉时，触发肌电图电位被认为是有用的；然而，这种方法在胸椎螺钉放置中不太被接受。
回顾了 30 例儿科畸形手术。所有螺钉均在透视辅助下放置。所有螺钉均获得肌电图数据。每位患者均行术后 CT 扫描。所有作者均对 CT 扫描进行评估，并对每个螺钉进行分类。确定肌电图>或=6 mA 的截断值的敏感性、特异性、阴性预测值和似然比。
共评估了 329 枚螺钉。无并发症发生。总体准确率为 93%。无螺钉出现>2 mm 内侧椎弓根壁穿透。由于内侧穿透，术中取出 9 枚螺钉。所有类别的螺钉的平均肌电图电位无统计学差异（P>0.1）。该试验的阴性预测值在胸椎为 0.92，在腰椎为 0.93。阴性似然比分别为胸椎 0.96 和腰椎 0.35，阳性似然比分别为胸椎 1.4 和腰椎 12.5。
胸椎和腰椎椎弓根螺钉是治疗小儿脊柱侧凸的安全手术选择。肌电图电位与术后 CT 扫描的比较显示，所有类别的螺钉均无统计学差异。在腰椎，肌电图检测的可能性比更具临床意义。肌电图值大于或等于 6 mA 极有可能表示该螺钉处于“安全区”。然而，没有真正的肌电图截断值可以保证准确的放置和避免神经损伤。
