Accuracy of intraoperative neuromonitoring during percutaneous cement discoplasty

Abstract

Introduction: Percutaneous cement discoplasty is a minimally invasive procedure to treat low back pain due to advanced degenerative disc disease in elderly patients. Complications of this procedure has been described such as infection, vertebral fracture, cement leakage and nerve injury. Intraoperative neuromonitoring is used to detect the latter. The objective of this study was to assess the usefulness of neuromonitoring during discoplasty to detect new neurological compromise. Methods: 100 consecutive patients were included in this retrospective study, (30 males and 70 females, mean age of 76.3 ± 5.71 years) with mechanical low back pain who underwent percutaneous cement discoplasty. Results: Sensitivity to detect neurological injury was 82% (CI 95% 66-98), specificity was of 99% (CI 95%98-100) with a positive predictive value of 0.95 (CI 95% 85-100) and a negative predictive value of 0.97 (CI 95% 95-99). In 5 patients neurological compromise was not detected by neuromonitoring. Discussion: Our study showed high sensitivity and specificity of neuromonitoring to detect neurological irritation during percutaneous discoplasty. Intraoperative neuromonitoring resulted an effective assistance during this minimally invasive procedure.

Critical Review of the State-of-the-Art on Lumbar Percutaneous Cement Discoplasty

“…Neuro-monitoring, installed during anaesthesia induction, allowed to prevent radicular irritation by changing the cannula entry point in their practice without increasing surgical length. A study on the utility of intraoperative neurophysiological monitoring during PCD reported a sensitivity of 82% and specificity of 99% ( 23 ). Before cement injection was introduced, one paper used a medium injected in the disc to assess the volume of required cement ( 17 ).…”