ABSTRACT
Introduction and objectivesMost of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws.Materials and methodsThis study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent).ResultsIn group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001).ConclusionsAdding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory (AU)
Introducción y objetivosLa mayor parte de los estudios que evaluaron el efecto de los enlaces cruzados en la estabilidad de la columna vertebral se realizaron in vitro en segmentos de la columna vertebral porcina o humana, existen pocos datos sobre los beneficios del aumento de los enlaces cruzados en las lesiones traumáticas. El objetivo de este estudio era evaluar los efectos de la inserción de enlaces cruzados entre las varillas en las tasas de fusión y la satisfacción posoperatoria de los pacientes con fracturas traumáticas toracolumbares que se habían sometido a fijación vertebral posterior con tornillos pediculares.Materiales y métodosEste estudio se realizó como un ensayo clínico aleatorizado de 60 pacientes que presentaban fracturas vertebrales toracolumbares traumáticas. Los pacientes se aleatorizaron en 3 grupos: A (sin ningún enlace cruzado), B (inserción de un enlace cruzado) y C (inserción de 2 enlaces cruzados). Se evaluaron los resultados 6 meses después de la intervención quirúrgica: tasas de fusión (radiografía simple y TC), dolor de espalda (escala analógica visual) y satisfacción del paciente (correcta, buena, excelente).ResultadosEn el grupo A, 13 (65%) pacientes presentaban fusión ósea estructural, pero en 7 (35%) pacientes no se observó fusión ósea. En los grupos B y C, 19 pacientes (95%) presentaban fusión ósea y solo en un paciente (5%) se observó el fracaso de la fusión (p=0,009). En el grupo A, la satisfacción más alta era correcta (8 pacientes [40%]) en comparación con los otros grupos. La mayor intensidad del dolor de espalda notificada se observó en el grupo A, mientras que la menor intensidad del dolor de espalda notificada se observó en el grupo B...(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Lumbar Vertebrae/injuries , Lumbar Vertebrae/surgery , Spinal Fractures/surgery , Thoracic Vertebrae/injuries , Thoracic Vertebrae/surgery , Fracture Fixation, Internal/methods , Patient Satisfaction , Treatment Outcome , Back PainABSTRACT
INTRODUCTION AND OBJECTIVES: Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients' satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. MATERIALS AND METHODS: This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). RESULTS: In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001). CONCLUSIONS: Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients' satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. TRIAL REGISTRATION NUMBER: IRCT20120527009878N3.
Subject(s)
Spinal Fractures , Back Pain , Fracture Fixation, Internal/methods , Humans , Lumbar Vertebrae/injuries , Lumbar Vertebrae/surgery , Patient Satisfaction , Spinal Fractures/surgery , Thoracic Vertebrae/injuries , Thoracic Vertebrae/surgeryABSTRACT
INTRODUCTION: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. METHOD: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. RESULT: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75). CONCLUSION: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity.
ABSTRACT
Introducción: La instrumentación con tornillos pediculares (TP) puede comprometer las estructuras neurales adyacentes. La electromiografía evocada (tEMG) es una modalidad del neuromonitoreo intraoperatorio utilizada para asistir la colocación de estos. El objetivo del presente estudio es evaluar la confiabilidad de esta herramienta. Método: Revisión retrospectiva de pacientes intervenidos de artrodesis lumbar posterolateral instrumentada desde enero del 2017 hasta diciembre del 2019. Se correlacionaron las imágenes de TC postoperatorias (TC-postop) con los resultados de la tEMG para cada TP con un umbral de 10mA, y se establecieron la sensibilidad y especificidad de esta herramienta. Se realizó test diagnóstico y la curva característica operativa del receptor para evaluar el área bajo la curva. Resultado: Se evaluaron 275 TP entre L1 y S1; 5 TP presentaban concordancia para una trayectoria inadecuada, mientras que 10TP, con tEMG <10mA, se encontraban correctamente posicionados. La TC-postop identificó 17 brechas pediculares no advertidas por la tEMG. La sensibilidad y la especificidad fue del 23% (IC 95%: 8-45) y 96% (IC 95%: 93-98), respectivamente, con un VPP del 33,3% y un VPN del 93,6%. El área bajo la curva fue de 0,74 (IC 95%: 0,62-0,86) con punto de corte de 24mA, que mostró una sensibilidad del 77% (IC 95%: 0,55-0,92) y una especificidad del 69% (IC 95%: 0,63-0,75). Conclusión: Dada su baja sensibilidad, no aconsejamos la tEMG como prueba única en la verificación de TP. Recomendamos la utilización de un punto de corte ≤8mA, ya que ha demostrado los niveles más altos de sensibilidad y especificidad. No recomendamos el uso de umbrales elevados para aumentar la sensibilidad.(AU)
Introduction: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. Method: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. Result: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75). Conclusion: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity.(AU)
Subject(s)
Electromyography , Spine/surgery , Back Injuries , Tomography, X-Ray Computed , Pedicle Screws , Sensitivity and Specificity , Retrospective Studies , Traumatology , General Surgery , OrthopedicsABSTRACT
Introduction: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. Method: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. Result: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75). Conclusion: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity.(AU)
Introducción: La instrumentación con tornillos pediculares (TP) puede comprometer las estructuras neurales adyacentes. La electromiografía evocada (tEMG) es una modalidad del neuromonitoreo intraoperatorio utilizada para asistir la colocación de estos. El objetivo del presente estudio es evaluar la confiabilidad de esta herramienta. Método: Revisión retrospectiva de pacientes intervenidos de artrodesis lumbar posterolateral instrumentada desde enero del 2017 hasta diciembre del 2019. Se correlacionaron las imágenes de TC postoperatorias (TC-postop) con los resultados de la tEMG para cada TP con un umbral de 10mA, y se establecieron la sensibilidad y especificidad de esta herramienta. Se realizó test diagnóstico y la curva característica operativa del receptor para evaluar el área bajo la curva. Resultado: Se evaluaron 275 TP entre L1 y S1; 5 TP presentaban concordancia para una trayectoria inadecuada, mientras que 10TP, con tEMG <10mA, se encontraban correctamente posicionados. La TC-postop identificó 17 brechas pediculares no advertidas por la tEMG. La sensibilidad y la especificidad fue del 23% (IC 95%: 8-45) y 96% (IC 95%: 93-98), respectivamente, con un VPP del 33,3% y un VPN del 93,6%. El área bajo la curva fue de 0,74 (IC 95%: 0,62-0,86) con punto de corte de 24mA, que mostró una sensibilidad del 77% (IC 95%: 0,55-0,92) y una especificidad del 69% (IC 95%: 0,63-0,75). Conclusión: Dada su baja sensibilidad, no aconsejamos la tEMG como prueba única en la verificación de TP. Recomendamos la utilización de un punto de corte ≤8mA, ya que ha demostrado los niveles más altos de sensibilidad y especificidad. No recomendamos el uso de umbrales elevados para aumentar la sensibilidad.(AU)
Subject(s)
Electromyography , Spine/surgery , Back Injuries , Tomography, X-Ray Computed , Pedicle Screws , Sensitivity and Specificity , Retrospective Studies , Traumatology , General Surgery , OrthopedicsABSTRACT
INTRODUCTION AND OBJECTIVES: Most of the studies evaluating the effect of cross links on spinal stability are performed in vitro on porcine or human spine segments and there is limited data regarding clinical benefits of cross link augmentation in traumatic injuries. In this study we aimed to evaluate the effects of cross-links insertion between rods on the fusion rates and post-surgical patients' satisfaction among patients with traumatic thoracolumbar fractures who underwent posterior spinal fixation with pedicle screws. MATERIALS AND METHODS: This study was conducted as a randomized clinical trial on 60 patients suffering from traumatic thoracolumbar vertebrae fractures. Patients were randomized into three groups: A (without any cross-link), B (One cross-link insertion) and C (two cross-links insertion). Six months after surgery outcomes were evaluated: fusion rates (plain X-ray and CT scan), Back pain (Visual Analog Scale) and patient satisfaction (fair, good, excellent). RESULTS: In group A 13 (65%) patients had structured bone fusion, but in 7 (35%) patients bone fusion was not observed. In both groups B and C, 19 patients (95%) had bone fusion, but only in 1 patient (5%) fusion failed (p=0.009). In group A, fair satisfaction has the highest rate (8 patients (40%)) compared to the other groups. The highest reported severity of back pain was observed in group A while the lowest reported intensity of back pain was related to group B (p=0.001). CONCLUSIONS: Adding cross link to posterior spinal fixations of patients with traumatic thoracolumbar fractures can be associated with better final fusion results and patients' satisfaction. However it is necessary to design studies with greater sample sizes to confirm this theory. TRIAL REGISTRATION NUMBER: IRCT20120527009878N3.
