在神经纤维瘤病 I 型脊柱侧凸手术中，t-EMG 与 O 臂辅助椎弓根螺钉置入联合应用的疗效和安全性。
Efficacy and safety for combination of t-EMG with O-arm assisted pedicle screw placement in neurofibromatosis type I scoliosis surgery.
机构信息
Spine Center, Xin Hua Hospital Affiliated To Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Shanghai, People's Republic of China.
Department of Spine Surgery, Sun Yat-Sen University First Affiliated Hospital, No. 58 Second Zhongshan Road, Guangzhou, Guangdong, People's Republic of China.
出版信息
J Orthop Surg Res. 2021 Dec 20;16(1):731. doi: 10.1186/s13018-021-02882-9.
BACKGROUND
Due to the characteristics of neurofibromatosis type I (NF-1) scoliosis, the precise placement of pedicle screws still remains to be a challenge. Triggered screw electromyography (t-EMG) has been proved to exhibit high sensitivity to identify mal-positioned pedicle screws, but no previous study assessed the combination of t-EMG with O-arm-assisted pedicle screw placement in NF-1 scoliosis surgery.
OBJECTIVE
To evaluate efficacy and safety for combination of t-EMG with O-arm-assisted pedicle screw placement in NF-1 scoliosis surgery.
MATERIALS AND METHODS
From March 2018 to April 2020, sixty-five NF-1 scoliosis patients underwent t-EMG and O-arm-assisted pedicle screw fixation were retrospectively reviewed. The channel classification system was applied to classify the pedicle morphology based on pedicle width measurement by preoperative computed tomography scans. The minimal t-EMG threshold for screw path inspection was used as 8 mA, and operative screw redirection was also recorded. All pedicle screws were verified using a second intraoperative O-arm scan. The correlation between demographic and clinical data with amplitude of t-EMG were also analyzed.
RESULTS
A total of 652 pedicle screws (T10-S1) in 65 patients were analyzed. The incidence of an absent pedicle (channel classification type C or D morphology) was 150 (23%). Overall, abnormal t-EMG threshold was identified in 26 patients with 48 screws (7.4%), while 16 out of the 48 screws were classified as G0, 14 out of the 48 screws were classified as G1, and 18 out of the 48 screws were classified as G2. The screw redirection rate was 2.8% (18/652). It showed that t-EMG stimulation detected 3 unacceptable mal-positioned screws in 2 patients (G2) which were missed by O-arm scan. No screw-related neurological or vascular complications were observed.
CONCLUSIONS
Combination of t-EMG with O-arm-assisted pedicle screw placement was demonstrated to be a safe and effective method in NF-1 scoliosis surgery. The t-EMG could contribute to detecting the rupture of the medial wall which might be missed by O-arm scan. Combination of t-EMG with O-arm could be recommended for routine use of screw insertion in NF-1 scoliosis surgery.
背景
由于神经纤维瘤病 1 型（NF-1）脊柱侧凸的特点，椎弓根螺钉的精确放置仍然是一个挑战。触发式螺钉肌电图（t-EMG）已被证明对识别定位不当的椎弓根螺钉具有很高的敏感性，但以前没有研究评估 t-EMG 与 O 臂辅助椎弓根螺钉放置在 NF-1 脊柱侧凸手术中的结合。
目的
评估 t-EMG 与 O 臂辅助 NF-1 脊柱侧凸手术中椎弓根螺钉放置相结合的疗效和安全性。
材料和方法
2018 年 3 月至 2020 年 4 月，回顾性分析了 65 例 NF-1 脊柱侧凸患者接受 t-EMG 和 O 臂辅助椎弓根螺钉固定的资料。根据术前 CT 扫描测量的椎弓根宽度，应用通道分类系统对椎弓根形态进行分类。用于检查螺钉路径的最小 t-EMG 阈值为 8 mA，并记录手术螺钉的重新定向。所有椎弓根螺钉均通过术中第二次 O 臂扫描进行验证。还分析了与 t-EMG 幅度相关的人口统计学和临床数据。
结果
共分析了 65 例患者的 652 枚 T10-S1 椎弓根螺钉。无椎弓根（通道分类 C 或 D 型）的发生率为 150 例（23%）。总的来说，26 例患者（48 枚螺钉）存在异常 t-EMG 阈值，其中 48 枚螺钉中 16 枚为 G0，14 枚为 G1，18 枚为 G2。螺钉重新定向率为 2.8%（18/652）。结果表明，t-EMG 刺激在 2 例患者（G2）中检测到 3 枚可接受的定位不良螺钉，而 O 臂扫描漏诊。未发现与螺钉相关的神经或血管并发症。
结论
t-EMG 与 O 臂辅助椎弓根螺钉放置相结合在 NF-1 脊柱侧凸手术中是一种安全有效的方法。t-EMG 有助于检测到可能被 O 臂扫描漏诊的内侧壁破裂。t-EMG 与 O 臂相结合可推荐用于 NF-1 脊柱侧凸手术中螺钉插入的常规使用。
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