Intraoperative Triggered Electromyography for Pedicle Screw Placement Under Spinal Anesthesia: A Preliminary Report

Abstract

BACKGROUND: Triggered electromyography (tEMG) is an intraoperative neuromonitoring technique used to assess pedicle screw placement during instrumented fusion procedures. Although spinal anesthesia is a safe alternative to general anesthesia in patients undergoing lumbar fusion, its use may potentially block conduction of triggered action potentials or may require higher threshold currents to elicit myotomal responses when using tEMG. Given the broad utilization of tEMG for confirmation of pedicle screw placement, adoption of spinal anesthesia may be hindered by limited studies of its use alongside tEMG. OBJECTIVE: To investigate whether spinal anesthesia affects the efficacy of tEMG, we compare the baseline spinal nerve thresholds during lumbar fusion procedures under general vs spinal anesthesia. METHODS: Twenty-three consecutive patients (12 general and 11 spinal) undergoing single-level transforaminal lumbar interbody fusion were included in the study. Baseline nerve threshold was determined through direct stimulation of the spinal nerve using tEMG. RESULTS: Baseline spinal nerve threshold did not differ between the general and spinal anesthesia cohorts (3.25 ± 1.14 vs 3.64 ± 2.16 mA, respectively; P = .949). General and spinal anesthesia cohorts did not differ by age, body mass index, American Society of Anesthesiologists score status, or surgical indication. CONCLUSION: We report that tEMG for pedicle screw placement can be safely and effectively used in procedures under spinal anesthesia. The baseline nerve threshold required to illicit a myotomal response did not differ between patients under general or spinal anesthesia. This preliminary finding suggests that spinal anesthetic blockade does not contraindicate the use of tEMG for neuromonitoring during pedicle screw placement.

Spinal anesthesia in elective lumbar spinal surgery

“…Contemporary spinal surgeons frequently utilize intraoperative neuromonitoring, which is a potential barrier to SA use. However, triggered electromyography, a common modality, has been found to remain feasible and efficacious for patients under SA during pedicle screw placement [ 51 ]. Intraoperative three-dimensional CT, which is also frequently performed in contemporary spine surgery, has likewise been shown to be feasible under SA [ 52 ].…”