Screw Stimulation Thresholds for Neuromonitoring in Minimally Invasive Oblique Lateral Lumbar Interbody Fusion (OLLIF): A Correlational Study

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2024 Jul 23

PMID 39040718

Authors

Hamid Abbasi

Dominic J Moore

Mohadese Rajaeirad

Jiawen Zhan

Affiliations

Soon will be listed here.

Abstract

Introduction: This study presents findings from an investigation into the correlation of neuromonitoring techniques in minimally invasive lumbar fusions and their open counterparts regarding acceptable thresholds for screw stimulation. The threshold for acceptable stimulation value for open surgery has been established. The study compared acceptable thresholds for open pedicle screws where there is more connection between the screw and the soft tissue.

Methods: The neuromonitoring data of 17 patients who underwent oblique lateral lumbar interbody fusion (OLLIF) procedures between September 2023 to May 2024 were reviewed. Neuromonitoring was conducted throughout surgeries, recording stimulation thresholds for pedicle screws insulated and uninsulated, to simulate the environment of a screw during open and minimally invasive surgery respectively. Patients' BMI was also collected for potential correlation analysis.

Results: Results indicate a discernible correlation between stimulation thresholds in open and minimally invasive surgeries, but no definitive correlation with BMI due to sample size limitations. Though a significant correlation between the two stimulating styles is apparent, there is a good correlation to suggest what threshold should determine a standard stimulation threshold for minimally invasive surgeries.

Conclusion: The study emphasizes the need for refined neuromonitoring strategies in minimally invasive spinal fusion (MISF) surgeries to ensure patient safety and surgical effectiveness. Further research with larger cohorts is recommended to establish optimized protocols that have a clearly defined amplitude for MISF thresholds.

References

Raynor B, Lenke L, Bridwell K, Taylor B, Padberg A . Correlation between low triggered electromyographic thresholds and lumbar pedicle screw malposition: analysis of 4857 screws. Spine (Phila Pa 1976). 2007; 32(24):2673-8. DOI: 10.1097/BRS.0b013e31815a524f. View

Abbasi H, Abbasi A . Oblique Lateral Lumbar Interbody Fusion (OLLIF): Technical Notes and Early Results of a Single Surgeon Comparative Study. Cureus. 2015; 7(10):e351. PMC: 4652919. DOI: 10.7759/cureus.351. View

Youssef J, McAfee P, Patty C, Raley E, DeBauche S, Shucosky E . Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine (Phila Pa 1976). 2010; 35(26 Suppl):S302-11. DOI: 10.1097/BRS.0b013e3182023438. View

Krassioukov A, Sarjeant R, Arkia H, Fehlings M . Multimodality intraoperative monitoring during complex lumbosacral procedures: indications, techniques, and long-term follow-up review of 61 consecutive cases. J Neurosurg Spine. 2004; 1(3):243-53. DOI: 10.3171/spi.2004.1.3.0243. View

Bono O, Poorman G, Foster N, Jalai C, Horn S, Oren J . Body mass index predicts risk of complications in lumbar spine surgery based on surgical invasiveness. Spine J. 2017; 18(7):1204-1210. DOI: 10.1016/j.spinee.2017.11.015. View

Wilson Jr J, Vallejo J, Kumbhare D, Guthikonda B, Hoang S . The Use of Intraoperative Neuromonitoring for Cervical Spine Surgery: Indications, Challenges, and Advances. J Clin Med. 2023; 12(14). PMC: 10380862. DOI: 10.3390/jcm12144652. View

Lee C, Kim H, Kim H, Lee C, Kim J, Sala F . Can triggered electromyography thresholds assure accurate pedicle screw placements? A systematic review and meta-analysis of diagnostic test accuracy. Clin Neurophysiol. 2015; 126(10):2019-25. DOI: 10.1016/j.clinph.2014.11.026. View

Amick M, Ottesen T, OMarr J, Frenkel M, Callahan B, Grauer J . Effects of anode position on pedicle screw testing during lumbosacral spinal fusion surgery. Spine J. 2022; 22(12):2000-2005. DOI: 10.1016/j.spinee.2022.07.090. View

Costa P, Bruno A, Bonzanino M, Massaro F, Caruso L, Vincenzo I . Somatosensory- and motor-evoked potential monitoring during spine and spinal cord surgery. Spinal Cord. 2006; 45(1):86-91. DOI: 10.1038/sj.sc.3101934. View

10.

Melachuri S, Melachuri M, Mina A, Anetakis K, Crammond D, Balzer J . Optimal "Low" Pedicle Screw Stimulation Threshold to Predict New Postoperative Lower-Extremity Neurologic Deficits During Lumbar Spinal Fusions. World Neurosurg. 2021; 151:e250-e256. DOI: 10.1016/j.wneu.2021.04.022. View

11.

Roberts T, Gabaldon A . Interpreting muscle function from EMG: lessons learned from direct measurements of muscle force. Integr Comp Biol. 2011; 48(2):312-20. PMC: 4817590. DOI: 10.1093/icb/icn056. View

12.

Park J, Hyun S . Intraoperative neurophysiological monitoring in spinal surgery. World J Clin Cases. 2015; 3(9):765-73. PMC: 4568525. DOI: 10.12998/wjcc.v3.i9.765. View

13.

Fehlings M, Brodke D, Norvell D, Dettori J . The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference?. Spine (Phila Pa 1976). 2010; 35(9 Suppl):S37-46. DOI: 10.1097/BRS.0b013e3181d8338e. View

14.

Abbasi H, Grant A . Effect of Body Mass Index on Perioperative Outcomes in Minimally Invasive Oblique Lateral Lumbar Interbody Fusion versus Open Fusions: A Multivariant Analysis. Cureus. 2018; 10(3):e2288. PMC: 5953510. DOI: 10.7759/cureus.2288. View

15.

Farina D, Merletti R, Enoka R . The extraction of neural strategies from the surface EMG. J Appl Physiol (1985). 2004; 96(4):1486-95. DOI: 10.1152/japplphysiol.01070.2003. View

16.

Alemo S, Sayadipour A . Role of intraoperative neurophysiologic monitoring in lumbosacral spine fusion and instrumentation: a retrospective study. World Neurosurg. 2010; 73(1):72-6. DOI: 10.1016/j.surneu.2009.04.024. View

17.

Charalampidis A, Jiang F, Wilson J, Badhiwala J, Brodke D, Fehlings M . The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery. Global Spine J. 2020; 10(1 Suppl):104S-114S. PMC: 6947672. DOI: 10.1177/2192568219859314. View

18.

Bose B, Wierzbowski L, Sestokas A . Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar spine surgery. Spine (Phila Pa 1976). 2002; 27(13):1444-50. DOI: 10.1097/00007632-200207010-00014. View