Woods Michael, Birkholz Denise, MacBarb Regina, Capobianco Robyn, Woods Adam
Missoula Bone and Joint, 2360 Mullan Road, Suite C, Missoula, MT 59808, USA.
Pronerve, 7600 East Orchard Road, Suite 200, Greenwood Village, CO 80111, USA.
Adv Orthop. 2014;2014:154041. doi: 10.1155/2014/154041. Epub 2014 Dec 4.
Study Design. Retrospective case series. Objective. To document the clinical utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion for patients diagnosed with sacroiliac joint dysfunction (as a direct result of sacroiliac joint disruptions or degenerative sacroiliitis) and determine stimulated electromyography thresholds reflective of favorable implant position. Summary of Background Data. Intraoperative neuromonitoring is a well-accepted adjunct to minimally invasive pedicle screw placement. The utility of intraoperative neuromonitoring during minimally invasive surgical sacroiliac joint fusion using a series of triangular, titanium porous plasma coated implants has not been evaluated. Methods. A medical chart review of consecutive patients treated with minimally invasive surgical sacroiliac joint fusion was undertaken at a single center. Baseline patient demographics and medical history, intraoperative electromyography thresholds, and perioperative adverse events were collected after obtaining IRB approval. Results. 111 implants were placed in 37 patients. Sensitivity of EMG was 80% and specificity was 97%. Intraoperative neuromonitoring potentially avoided neurologic sequelae as a result of improper positioning in 7% of implants. Conclusions. The results of this study suggest that intraoperative neuromonitoring may be a useful adjunct to minimally invasive surgical sacroiliac joint fusion in avoiding nerve injury during implant placement.
研究设计。回顾性病例系列研究。目的。记录术中神经监测在诊断为骶髂关节功能障碍（由骶髂关节破坏或退行性骶髂关节炎直接导致）患者的微创骶髂关节融合术中的临床应用，并确定反映植入物位置良好的刺激肌电图阈值。背景资料总结。术中神经监测是微创椎弓根螺钉置入术广泛接受的辅助手段。使用一系列三角形钛多孔等离子涂层植入物进行微创骶髂关节融合术中术中神经监测的效用尚未得到评估。方法。在单一中心对接受微创骶髂关节融合术的连续患者进行病历回顾。在获得机构审查委员会批准后，收集患者基线人口统计学和病史、术中肌电图阈值以及围手术期不良事件。结果。37例患者共置入111枚植入物。肌电图的敏感性为80%，特异性为97%。术中神经监测可能避免了7%的植入物因位置不当导致的神经后遗症。结论。本研究结果表明，术中神经监测可能是微创骶髂关节融合术的有用辅助手段，可避免植入物放置过程中的神经损伤。
