Accuracy of intraoperative neuromonitoring during percutaneous cement discoplasty

Authors

  • Gaston Oscar Camino Willhuber Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina. http://orcid.org/0000-0002-5684-7679
  • Mariana Bendersky III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Paraguay 2155, Buenos Aires, Argentina. http://orcid.org/0000-0002-8945-9920
  • Carolina Vilte Intraoperative Monitoring, Pediatric Neurology Department, Italian Hospital of Buenos Aires, Potosi 4215, Buenos Aires, Argentina.
  • Gonzalo Kido Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.
  • Matias Pereira Duarte Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.
  • Martin Estefan Intraoperative Monitoring, Pediatric Neurology Department, Italian Hospital of Buenos Aires, Potosi 4215, Buenos Aires, Argentina.
  • Julio Bassani Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.
  • Matias Petracchi Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.
  • Marcelo Gruenberg Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.
  • Carlos Sola Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.

DOI:

https://doi.org/10.31053/1853.0605.v78.n3.32619

Keywords:

scoliosis, back pain, spinal diseases

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.

 

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Author Biographies

Gaston Oscar Camino Willhuber, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.

 

Dr. Camino Willhuber is Associate Physician of the Orthopedics and Traumatology Service of the Italian Hospital of Buenos Aires.

Mariana Bendersky, III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Paraguay 2155, Buenos Aires, Argentina.

Bibliographic summary:
Dr. Mariana Bendersky is a Neurologist, at the Italian Hospital in Buenos Aires
and a Phd researcher at the Department of Normal Anatomy at the University of
Buenos Aires.  

Carolina Vilte, Intraoperative Monitoring, Pediatric Neurology Department, Italian Hospital of Buenos Aires, Potosi 4215, Buenos Aires, Argentina.

Bibliographic Summary:
Dr. Carolina Vilte works as a fellow for the improvement of the Neurology service
of the Italian Hospital of Buenos Aires.

Gonzalo Kido, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.

Bibliographic Summary:
Dr. Gonzalo Kido is an associate physician at the Orthopedics and Traumatology
Service of Hospital Italiano de Buenos Aires.

Matias Pereira Duarte, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.

Bibliographic Summary:
Dr. Pereira Duarte is an associate physician at the Orthopedics and Traumatology
Service of Hospital Italiano de Buenos Aires.

 

Martin Estefan, Intraoperative Monitoring, Pediatric Neurology Department, Italian Hospital of Buenos Aires, Potosi 4215, Buenos Aires, Argentina.

Bibliographic Summary: Dr. Estefan is an associate physician at the Orthopedics and Traumatology Service of Hospital Italiano de Buenos Aires.            

Julio Bassani, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.

Bibliographic Summary: Dr. Bassani is an associate physician at the Orthopedics and Traumatology Service of Hospital Italiano de Buenos Aires.        

Matias Petracchi, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.

Bibliographic Summary:
Dr Petracchi is a Staff Physician of the Orthopedics and Traumatology
service of the Italian Hospital of Buenos Aires

Marcelo Gruenberg, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.

Bibliographic Summary: Dr. Gruenberg is a Staff Physician of the Orthopedics
and Traumatology service of the Italian Hospital of Buenos Aires.

Carlos Sola, Institute of Orthopedics “Carlos E. Ottolenghi,” Hospital Italiano de Buenos Aires, Potosí 4215, Buenos Aires, Argentina.

Bibliographic Summary: Dr Sola is a Staff Physician of the Orthopedics and
Traumatology service of the Italian Hospital of Buenos Aires.

References

Varga PP, Jakab G, Bors IB, Lazary A, Szövérfi Z. Erfahrungen mit PMMA-Zement als intervertebraler Stand-alone-Platzhalter. Perkutane Zement-Diskoplastie bei Vakuumphänomen der lumbalen Bandscheiben [Experiences with PMMA cement as a stand-alone intervertebral spacer. Percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs]. Orthopade. 2015 Feb;44(2):124-31. German. doi: 10.1007/s00132-015-3092-1.

Yamada K, Nakamae T, Shimbo T, Kanazawa T, Okuda T, Takata H, Hashimoto T, Hiramatsu T, Tanaka N, Olmarker K, Fujimoto Y. Targeted Therapy for Low Back Pain in Elderly Degenerative Lumbar Scoliosis: A Cohort Study. Spine (Phila Pa 1976). 2016 May;41(10):872-9. doi: 10.1097/BRS.0000000000001524.

Yamada K, Nakamae T, Nakanishi K, Kamei N, Hiramatsu T, Okuda T, Hashimoto T, Ujigo S, Morisako T, Tsuchikawa Y, Maruyama T, Fukui H, Adachi N, Shimbo T, Olmarker K, Fujimoto Y. Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis. Eur Spine J. 2021 Jul;30(7):2020-2032. doi: 10.1007/s00586-021-06805-4.

Sola C, Camino Willhuber G, Kido G, Pereira Duarte M, Bendersky M, Mereles M, Petracchi M, Gruenberg M. Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients. Eur Spine J. 2021 Aug;30(8):2200-2208. doi: 10.1007/s00586-018-5547-7.

Camino Willhuber G, Kido G, Pereira Duarte M, Estefan M, Bendersky M, Bassani J, Petracchi M, Gruenberg M, Sola C. Percutaneous Cement Discoplasty for the Treatment of Advanced Degenerative Disc Conditions: A Case Series Analysis. Global Spine J. 2020 Sep;10(6):729-734. doi: 10.1177/2192568219873885.

Kiss L, Varga PP, Szoverfi Z, Jakab G, Eltes PE, Lazary A. Indirect foraminal decompression and improvement in the lumbar alignment after percutaneous cement discoplasty. Eur Spine J. 2019 Jun;28(6):1441-1447. doi: 10.1007/s00586-019-05966-7.

Fehlings MG, Brodke DS, Norvell DC, Dettori JR. The evidence for intraoperative neurophysiological monitoring in spine surgery: does it make a difference? Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S37-46. doi: 10.1097/BRS.0b013e3181d8338e.

Tamkus AA, Rice KS, McCaffrey MT. Perils of intraoperative neurophysiological monitoring: analysis of "false-negative" results in spine surgeries. Spine J. 2018 Feb;18(2):276-284. doi: 10.1016/j.spinee.2017.07.005.

Lall RR, Lall RR, Hauptman JS, Munoz C, Cybulski GR, Koski T, Ganju A, Fessler RG, Smith ZA. Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist. Neurosurg Focus. 2012 Nov;33(5):E10. doi: 10.3171/2012.9.FOCUS12235.

Camino Willhuber G, Bendersky M, De Cicco FL, Kido G, Duarte MP, Estefan M, Petracchi M, Gruenberg M, Sola C. Development of a New Therapy-Oriented Classification of Intervertebral Vacuum Phenomenon With Evaluation of Intra- and Interobserver Reliabilities. Global Spine J. 2021 May;11(4):480-487. doi: 10.1177/2192568220913006.

Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, Kulik G. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976). 2010 Oct 1;35(21):1919-24. doi: 10.1097/BRS.0b013e3181d359bd.

Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results. Clin Orthop Relat Res. 1986 Jun;(207):37-43.

Daniel JW, Botelho RV, Milano JB, Dantas FR, Onishi FJ, Neto ER, Bertolini EF, Borgheresi MAD, Joaquim AF. Intraoperative Neurophysiological Monitoring in Spine Surgery: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976). 2018 Aug;43(16):1154-1160. doi: 10.1097/BRS.0000000000002575.

Garces J, Berry JF, Valle-Giler EP, Sulaiman WA. Intraoperative neurophysiological monitoring for minimally invasive 1- and 2-level transforaminal lumbar interbody fusion: does it improve patient outcome? Ochsner J. 2014 Spring;14(1):57-61.

Scibilia A, Raffa G, Rizzo V, Quartarone A, Visocchi M, Germanò A, Tomasello F. Intraoperative Neurophysiological Monitoring in Spine Surgery: A Significant Tool for Neuronal Protection and Functional Restoration. Acta Neurochir Suppl. 2017;124:263-270. doi: 10.1007/978-3-319-39546-3_38.

Sutter M, Eggspuehler A, Jeszenszky D, Kleinstueck F, Fekete TF, Haschtmann D, Porchet F, Dvorak J. The impact and value of uni- and multimodal intraoperative neurophysiological monitoring (IONM) on neurological complications during spine surgery: a prospective study of 2728 patients. Eur Spine J. 2019 Mar;28(3):599-610. doi: 10.1007/s00586-018-5861-0.

Kaliya-Perumal AK, Charng JR, Niu CC, Tsai TT, Lai PL, Chen LH, Chen WJ. Intraoperative electromyographic monitoring to optimize safe lumbar pedicle screw placement - a retrospective analysis. BMC Musculoskelet Disord. 2017 May 30;18(1):229. doi: 10.1186/s12891-017-1594-1

Charalampidis A, Jiang F, Wilson JRF, Badhiwala JH, Brodke DS, Fehlings MG. The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery. Global Spine J. 2020 Jan;10(1 Suppl):104S-114S. doi: 10.1177/2192568219859314.

Lazary A. Expert's Comment concerning Grand Rounds Case entitled "Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients" : (C. Sola, et al., Eur Spine J; 2018: DOI 10.1007/s00586-018-5547-7). Eur Spine J. 2021 Aug;30(8):2209-2210. doi: 10.1007/s00586-020-06568-4.

Ozer AF, Suzer T, Can H, Falsafi M, Aydin M, Sasani M, Oktenoglu T. Anatomic Assessment of Variations in Kambin's Triangle: A Surgical and Cadaver Study. World Neurosurg. 2017 Apr;100:498-503. doi: 10.1016/j.wneu.2017.01.057.

Zhang L, Yang J, Hai Y, Yin P, Ding Y, Xu C, Gao H. Relationship of the Exiting Nerve Root and Superior Articular Process in Kambin's Triangle: Assessment of Lumbar Anatomy Using Cadavers and Computed Tomography Imaging. World Neurosurg. 2020 May;137:e336-e342. doi: 10.1016/j.wneu.2020.01.195.

Hoshide R, Feldman E, Taylor W. Cadaveric Analysis of the Kambin's Triangle. Cureus. 2016 Feb 2;8(2):e475. doi: 10.7759/cureus.475

Fanous AA, Tumialán LM, Wang MY. Kambin's triangle: definition and new classification schema. J Neurosurg Spine. 2019 Nov 29:1-9. doi: 10.3171/2019.8.SPINE181475. Epub ahead of print.

Ahn Y, Lee SH, Lee JH, Kim JU, Liu WC. Transforaminal percutaneous endoscopic lumbar discectomy for upper lumbar disc herniation: clinical outcome, prognostic factors, and technical consideration. Acta Neurochir (Wien). 2009 Mar;151(3):199-206. doi: 10.1007/s00701-009-0204-x. Epub 2009 Feb 20. Erratum in: Acta Neurochir (Wien). 2009 Nov;151(11):1561.

Yeung AT, Tsou PM. Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine (Phila Pa 1976). 2002 Apr 1;27(7):722-31. doi: 10.1097/00007632-200204010-00009.

Lertudomphonwanit T, Keorochana G, Kraiwattanapong C, Chanplakorn P, Leelapattana P, Wajanavisit W. Anatomic Considerations of Intervertebral Disc Perspective in Lumbar Posterolateral Approach via Kambin's Triangle: Cadaveric Study. Asian Spine J. 2016 Oct;10(5):821-827. doi: 10.4184/asj.2016.10.5.821.

Schmidt CK, Rustagi T, Alonso F, Loukas M, Chapman JR, Oskouian RJ, Tubbs RS. Nerve root anomalies: making sense of a complicated literature. Childs Nerv Syst. 2017 Aug;33(8):1261-1273. doi: 10.1007/s00381-017-3457-3.

Can H, Kircelli A, Kavadar G, Civelek E, Cansever T, Aydoseli A, Onal MB, Yilmaz C. Lumbosacral Conjoined Root Anomaly: Anatomical Considerations of Exiting Angles and Root Thickness. Turk Neurosurg. 2017;27(4):617-622. doi: 10.5137/1019-5149.JTN.16490-15.1.

Rivner MH. Statistical errors and their effect on electrodiagnostic medicine. Muscle Nerve. 1994 Jul;17(7):811-4. doi: 10.1002/mus.880170718.

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Published

2021-08-23

How to Cite

1.
Camino Willhuber GO, Bendersky M, Vilte C, Kido G, Pereira Duarte M, Estefan M, Bassani J, Petracchi M, Gruenberg M, Sola C. Accuracy of intraoperative neuromonitoring during percutaneous cement discoplasty. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2021 Aug. 23 [cited 2024 Aug. 16];78(3):257-63. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/32619

Issue

Vol. 78 No. 3 (2021)

Section

Original Papers

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