PMID- 32689992
OWN - NLM
STAT- MEDLINE
DCOM- 20210514
LR  - 20210514
IS  - 1471-2474 (Electronic)
IS  - 1471-2474 (Linking)
VI  - 21
IP  - 1
DP  - 2020 Jul 20
TI  - Diagnostic accuracy of perioperative electromyography in the positioning of 
      pedicle screws in adolescent idiopathic scoliosis treatment: a cross-sectional 
      diagnostic study.
PG  - 473
LID - 10.1186/s12891-020-03491-z [doi]
LID - 473
AB  - BACKGROUND: To investigate in the conventional techniques of the pedicle screws 
      using triggered screw electromyography (t-EMG), considering different threshold 
      cutoffs: 10, 15, 20 25 mA, for predicting pedicle screw positioning during 
      surgery of the adolescent with idiopathic scoliosis (AIS). METHODS: Sixteen 
      patients (4 males, 12 females, average age 16.6 years) were included, with an 
      average curve magnitude of 50 degrees and placement of 226 pedicle screws. Each 
      screw was classified as "at risk for nerve injury" (ARNI) or "no risk for nerve 
      injury" (NRNI) using CT and the diagnostic accuracy of EMG considering different 
      threshold cutoffs (10,15, 20 and 25 mA) in the axial and Sagittal planes for 
      predicting screw positions ARNI was investigated. RESULTS: The EMG exam accuracy, 
      in the axial plane, 90.3% screws were considered NRNI. In the sagittal plane, 81% 
      pedicle screws were considered NRNI. A 1-mA decrease in the EMG threshold was 
      associated with a 12% increase in the odds of the screw position ARNI. In the 
      axial and sagittal planes, the ORs were 1.09 and 1.12, respectively. At every 
      threshold cutoff evaluated, the PPV of EMG for predicting screws ARNI was very 
      low in the different threshold cutoff (10 and 15); the highest PPV was 18% with a 
      threshold cutoff of 25 mA. The PPV was always slightly higher for predicting 
      screws ARNI in the sagittal plane than in the axial plane. In contrast, there was 
      a moderate to high NPV (78-93%) for every cutoff analyzed. CONCLUSIONS: EMG had a 
      moderate to high accuracy for positive predicting value screws ARNI with increase 
      threshold cutoffs of 20 and 25 mA. In addition, showed to be effective for 
      minimizing false-negative screws ARNI in the different threshold cutoffs of the 
      EMG in adolescent with idiopathic scoliosis (AIS).
FAU - Barsotti, Carlos Eduardo
AU  - Barsotti CE
AUID- ORCID: 0000-0003-3964-309X
AD  - Spine Group, Institute of Medical Assistance to the State Public Hospital Servant 
      - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 
      180, Sao Paulo, SP, CEP: 04038-034, Brazil. cadubarsotti@gmail.com.
FAU - Gavassi, Bruno Moreira
AU  - Gavassi BM
AD  - Spine Group, Institute of Medical Assistance to the State Public Hospital Servant 
      - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 
      180, Sao Paulo, SP, CEP: 04038-034, Brazil.
FAU - Prado, Francisco Eugenio
AU  - Prado FE
AD  - Spine Group, Institute of Medical Assistance to the State Public Hospital Servant 
      - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 
      180, Sao Paulo, SP, CEP: 04038-034, Brazil.
FAU - Batista, Bernardo Nogueira
AU  - Batista BN
AD  - Spine Group, Institute of Medical Assistance to the State Public Hospital Servant 
      - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 
      180, Sao Paulo, SP, CEP: 04038-034, Brazil.
FAU - de Resende Pratali, Raphael
AU  - de Resende Pratali R
AD  - Spine Group, Institute of Medical Assistance to the State Public Hospital Servant 
      - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 
      180, Sao Paulo, SP, CEP: 04038-034, Brazil.
FAU - Ribeiro, Ana Paula
AU  - Ribeiro AP
AD  - School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil.
FAU - de Oliveira, Carlos Eduardo Soares
AU  - de Oliveira CES
AD  - Spine Group, Institute of Medical Assistance to the State Public Hospital Servant 
      - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 
      180, Sao Paulo, SP, CEP: 04038-034, Brazil.
FAU - Ferreira, Ricardo Rodrigues
AU  - Ferreira RR
AD  - Spine Group, Institute of Medical Assistance to the State Public Hospital Servant 
      - IAMSPE, Centro de Estudos de Ortopedia, Rua Borges Lagoa, 1755, 1 andar - sala 
      180, Sao Paulo, SP, CEP: 04038-034, Brazil.
AD  - School of Medicine, University of Sao Paulo, Sao Paulo, SP, Brazil.
LA  - eng
PT  - Journal Article
DEP - 20200720
PL  - England
TA  - BMC Musculoskelet Disord
JT  - BMC musculoskeletal disorders
JID - 100968565
SB  - IM
MH  - Adolescent
MH  - Cross-Sectional Studies
MH  - Electromyography
MH  - Female
MH  - Humans
MH  - Male
MH  - *Pedicle Screws
MH  - *Scoliosis/diagnostic imaging/surgery
MH  - *Spinal Fusion/adverse effects
MH  - Thoracic Vertebrae
PMC - PMC7372782
OTO - NOTNLM
OT  - Bone screw
OT  - Computed tomographic scan
OT  - Electromyography
OT  - Intraoperative neurophysiological monitoring
OT  - Pedicle screw
OT  - Scoliosis
COIS- All Authors declare that they have no conflict of interest.
EDAT- 2020/07/22 06:00
MHDA- 2021/05/15 06:00
PMCR- 2020/07/20
CRDT- 2020/07/22 06:00
PHST- 2019/08/06 00:00 [received]
PHST- 2020/07/07 00:00 [accepted]
PHST- 2020/07/22 06:00 [entrez]
PHST- 2020/07/22 06:00 [pubmed]
PHST- 2021/05/15 06:00 [medline]
PHST- 2020/07/20 00:00 [pmc-release]
AID - 10.1186/s12891-020-03491-z [pii]
AID - 3491 [pii]
AID - 10.1186/s12891-020-03491-z [doi]
PST - epublish
SO  - BMC Musculoskelet Disord. 2020 Jul 20;21(1):473. doi: 10.1186/s12891-020-03491-z.