Neuromonitoring with pulse-train stimulation for implantation of thoracic pedicle screws: a blinded and randomized clinical study. Part 2. The role of feedback.

Object: The authors have reported in Part 1 of this study on a novel neuromonitoring test for the prevention of medial malpositioning of thoracic pedicle screws. In the present paper they examine the impact of providing the results of the test as intraoperative feedback to the surgical team.

Methods: This is the second part of a 2-part report of a prospective, blinded and randomized neuromonitoring study designed to lower the incidence of medially malpositioned thoracic pedicle screws.

Neuromonitoring with pulse-train stimulation for implantation of thoracic pedicle screws: a blinded and randomized clinical study. Part 1. Methods and alarm criteria.

Object: Reports of the accuracy of existing neuromonitoring methods for detecting or preventing medial malpositioning of thoracic pedicle screws have varied widely in their claimed effectiveness. The object of this study was to develop, test, and validate a novel neuromonitoring method for preventing medial malpositioning of pedicle screws in the thoracic spine during surgery.

Methods: This is a prospective, blinded and randomized study using a novel combination of input (4-pulse stimulus trains delivered within the pedicle track) and output (evoked electromyography from leg muscles) to detect pedicle track trajectories that-once implanted with a screw-would cause that screw to breach the pedicle's medial wall and encroach upon the spinal canal.

Is in vivo manual palpation for thoracic pedicle screw instrumentation reliable?

Object: Previous reports on the accuracy of manual palpation for thoracic pedicle screw placement have been restricted to cadaveric studies. Authors of the present novel study assessed the accuracy of manual palpation for the detection of medial and lateral pedicle breaches during thoracic spine surgery in living adult humans.

Methods: Pedicle tracks were created freehand and manually palpated using a ball-tipped probe.

Intraoperative neuromonitoring: can the results of direct stimulation of titanium-alloy pedicle screws in the thoracic spine be trusted?

Unlabelled: OBJECTVIE: Intraoperative neuromonitoring of thoracic-level pedicle screw implantation for detecting breaches in the pedicle cortex has adopted methods originally developed in the early 1990s for stainless steel (SS) alloy screws used at lumbosacral levels. In our recent attempts to monitor thoracic-level pedicle screw placement, we were surprised to find that these widely used stimulation parameters were largely ineffectual when stimulating directly through titanium alloy (Ti-alloy) pedicle screws. The objectives of this study, then, were twofold: (1) to report the number of episodes in which intraoperative neuromonitoring of thoracic screw position failed to detect a medially directed breach (or malplacement) in a previously described and limited sample set; and (2) to compare the frequency-specific impedance of a sample of Ti-alloy pedicle screws to comparably sized screws made of SS alloys.

Pulse-train stimulation for detecting medial malpositioning of thoracic pedicle screws.

Study Design: Thoracic pedicle screw location and the current needed to stimulate adjacent neural tissue was evaluated using brief, high-frequency pulse trains and monitoring electromyography (EMG) from muscles in the lower limbs.

Objective: To establish a safe and reliable method for detecting medial malpositioning of pedicle screws placed in the thoracic spine during instrumentation and fusion.

Summary Of Background Data: Neurophysiologic studies for testing thoracic pedicle screw placement used single-pulse stimulation and monitored EMG from thoracic-innervated muscles.

Operative techniques for fusion across the cervical-thoracic junction.

Background And Significance: The cervical-thoracic junction represents a significant challenge for stabilization because of anatomical constraints.

Purpose: To review the indications, techniques, and results of various stabilization techniques applied to the cervical-thoracic junction.

Conclusions: Innovative instrumentation design, improved operative techniques, and detailed knowledge of the regional anatomy and biomechanics have significantly improved the surgeon's ability to address instability at the cervical-thoracic junction.

Single-stage treatment of pyogenic spinal infection with titanium mesh cages.

Study Design: Single institution retrospective review.

Objectives: To report a series of pyogenic spinal infections treated with single-stage debridement and reconstruction with titanium mesh cages.

Summary Of Background Data: Various studies have reported surgical results of pyogenic spinal osteomyelitis with anterior debridement, strut grafting and fusion, including delayed posterior spinal instrumentation.

Cranial burr holes and emergency craniotomy: review of indications and technique.

Burr hole craniotomy for posttraumatic intracranial hematoma is rarely performed since the advent of computerized tomography revolutionized the treatment of these patients. It is still necessary in unique circumstances although, and the clinical urgency may require surgery by a non-neurosurgeon. This occurs rarely in rural or overseas locations in peacetime, but more commonly in combat health support operations where computed tomography and neurosurgeons are not widely available.

Weapons of mass destruction: biological.

Humans are susceptible to microbial infections from many sources. Biological warfare is the use of microbial forms of life to diminish the capabilities, disrupt the organization, and terrorize the noncombatant population of an adversary. This form of warfare has been used throughout history and has gained renewed interest with the current use of asymmetrical warfare.

Socioeconomic issues of United States military neurosurgery.

Although the practice of neurosurgery in the United States (US) Armed Forces is in many ways similar to the civilian practice of neurosurgery, there are many differences as well. The unique challenges, duties, and opportunities US military neurosurgeons are given, both in peacetime and in times of conflict, are discussed, as are pathways for entering into service. The advantages of military service for neurosurgeons include sponsored training, decreased direct exposure to tort actions, little involvement with third-party payers, significant opportunities for travel, and military specific experiences.

Combined anterior-posterior fusion with laterally placed threaded interbody cages and pedicle screws for Scheuermann kyphosis. Case report and review of the literature.

The authors report their preferred method for correcting Scheuermann disease via a combined anterior-posterior approach; their procedure is associated with a lower morbidity rate than the standard approach. Twenty-month followup examination demonstrated excellent maintenance of correction. The results satisfied the requirements to function without restriction in a vigorous military environment.

Thoracic hemivertebra excision in adults via a posterior-only approach. Report of two cases.

Hemivertebrae are a common cause of congenital scoliosis. Depending on their location and the magnitude of the resultant deformity, they may be asymptomatic or require treatment. In the past, treatment has focused on prevention of deformity progression in growing children.