Intraoperative triggered electromyographic monitoring of pedicle screw efficiently reduces the lumbar pedicle breach and re-operative rate-a retrospective analysis based on postoperative computed tomography scan.

BACKGROUND: To investigate whether intraoperative triggered electromyographic (T-EMG) monitoring could effectively reduce the breach rate of pedicle screws and the revision rate. METHODS: Patients with posterior pedicle screw fixation from L1-S1 were enrolled between June 2015 and May 2021. The patients in whom T-EMG was utilized were placed in the T-EMG group, and the remaining patients were considered in the non-T-EMG group. Three spine surgeons evaluated the images. The two groups were divided into subgroups based on screw position (lateral/superior and medial/inferior) and breach degree (minor and major). Patient demographics, screw positions, and revision procedures were reviewed. RESULTS: A total of 713 patients (3403 screws) who underwent postoperative computed tomography (CT) scans were included. Intraobserver and interobserver reliabilities were perfect. The T-EMG and non-T-EMG groups had 374(1723 screws) and 339 (1680 screws) cases, respectively. T-EMG monitoring efficiently reduced the overall screw breach (T-EMG 7.78% vs. non-T-EMG 11.25%, p = 0.001). in the subgroup analysis, the medial/inferior breach rate was higher in the T-EMG group than in the non-T-EMG group (T-EMG 6.27% vs. non-T-EMG 8.93%, p = 0.002); however, no difference was observed between the lateral and superior breaches (p = 0.064). A significant difference was observed between the minor (T-EMG 6.21% vs. non-T-EMG 8.33%, p = 0.001) and major (T-EMG 0.06% vs. non-T-EMG 0.6%, p = 0.001) medial or inferior screw breach rates. Six screws (all in the non-T-EMG group) underwent revision, with a significant difference between the groups (T-EMG 0.0% vs. non-T-EMG 3.17%, p = 0.044). CONCLUSIONS: T-EMG is a valuable tool in improving the accuracy of screw placement and reducing the screw revision rate. The screw-nerve root distance is vital in causing symptomatic screw breach. TRIAL REGISTRATION: The study is retrospective registered in China National Medical Research Registration and Archival information system in Nov 17th 2022.

Anterior cervical discectomy and fusion plus plating for unstable Hangman's fractures / 中华创伤杂志

Objective@#To investigate the clinical effectiveness of anterior cervical discectomy and fusion (ACDF)plus plating in the treatment of unstable Hangman's fractures.@*Methods@#A retrospective case series study was carried out to analyze 12 patients who received ACDF plus plate internal fixation for unstable Hangman's fracture admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from July 2014 to July 2018. There were nine males and three females, aged 24-70 years with an average of 46.2 years. According to Levine-Edwards typing, there were seven patients of type Ⅱ, four patients of type Ⅱ A and one patient of type Ⅲ. There were two patients of grade D and 10 patients of grade E according to the American Spinal Injury Association (ASIA) classification. The operation time, intraoperative blood loss and the operational complications were recorded. At 3 days, 1, 3, 6, 12 and 24 months after operation, the height of intervertebral disc, physiological curvature of cervical spine, fracture healing and bone graft fusion were evaluated. The recovery of neurological function was assessed by ASIA, and the neck pain relief and function improvement was assessed by visual analogue scale (VAS) and the neck disability index (NDI).@*Results@#All patients were followed for 6-48 months(mean, 27.7 months). The operation time ranged from 50-100 minutes, with an average of 72.5 minutes. The intraoperative blood loss was 30-120 ml (mean, 65.8 ml). No serious complications occurred during and after operation. Two patients had dysphagia after operation, and the symptoms were relieved at the follow-up of 3 months. All patients achieved bony fusion of C2-3 within the 6 month follow-up. No subsidence or migration of cages and significant loss of intervertebral space height were observed. The patient's neck and occipital pain was relieved obviously, and the flexion, extension and rotation of cervical spine were good. The neurologic dysfunction of two patients of ASIA Grade D recovered after surgery, and the final ASIA grade was E. The VAS score was decreased from 5.0 (4.0, 6.0)points preoperatively to 1.0(0, 1.0)points at the last follow-up (P<0.01). The NDI score was improved from (28.5±6.4)points preoperatively to (5.3±2.7)points at the last follow-up (P<0.01).@*Conclusion@#ACDF combined with plate internal fixation can provide immediate postoperative stability, high fusion rate, less complications, less pain, and satisfactory function recovery.

Anterior cervical discectomy and fusion plus plating for unstable Hangman's fractures / 中华创伤杂志

Objective To investigate the clinical effectiveness of anterior cervical discectomy and fusion (ACDF)plus plating in the treatment of unstable Hangman's fractures.Methods A retrospective case series study was carried out to analyze 12 patients who received ACDF plus plate internal fixation for unstable Hangman's fracture admitted to Sir Run Run Shaw Hospital affiliated to Zhejiang University School of Medicine from July 2014 to July 2018.There were nine males and three females,aged 24-70 years with an average of 46.2 years.According to Levine-Edwards typing,there were seven patients of type Ⅱ,four patients of type Ⅱ A and one patient of type Ⅲ.There were two patients of grade D and 10 patients of grade E according to the American Spinal Injury Association (ASIA) classification.The operation time,intraoperative blood loss and the operational complications were recorded.At 3 days,1,3,6,12 and 24 months after operation,the height of intervertebral disc,physiological curvature of cervical spine,fracture healing and bone graft fusion were evaluated.The recovery of neurological function was assessed by ASIA,and the neck pain relief and function improvement was assessed by visual analogue scale (VAS) and the neck disability index (NDI).Results All patients were followed for 6-48 months(mean,27.7 months).The operation time ranged from 50-100 minutes,with an average of 72.5 minutes.The intraoperative blood loss was 30-120 ml (mean,65.8 ml).No serious complications occurred during and after operation.Two patients had dysphagia after operation,and the symptoms were relieved at the follow-up of 3 months.All patients achieved bony fusion of C2-3 within the 6 month follow-up.No subsidence or migration of cages and significant loss of intervertebral space height were observed.The patient's neck and occipital pain was relieved obviously,and the flexion,extension and rotation of cervical spine were good.The neurologic dysfunction of two patients of ASIA Grade D recovered after surgery,and the final ASIA grade was E.The VAS score was decreased from 5.0 (4.0,6.0)points preoperatively to 1.0(0,1.0)points at the last follow-up (P ＜0.01).The NDI score was improved from (28.5 ± 6.4) points preoperatively to (5.3 ± 2.7) points at the last follow-up (P＜0.01).Conclusion ACDF combined with plate internal fixation can provide immediate postoperative stability,high fusion rate,less complications,less pain,and satisfactory function recovery.