Technical note: Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion

Michael Neil Woodall, Basheer Shakir, Adam Smitherman, Haroon F Choudhri

Research output: Contribution to journalArticle

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Abstract

Purpose: The lateral transpsoas interbody fusion (LTIF) is an increasingly popular minimally invasive technique for lumbar interbody fusion. Although a posterior approach to the lumbar spine has traditionally been favored for the treatment of canal stenosis and neural foraminal stenosis, a growing body of evidence suggests that indirect decompression of the spinal canal and neural foramen can be achieved using a lateral transpsoas approach to the lumbar spine. We present 2 cases that may suggest a role for spontaneous electromyography (s-EMG) monitoring in assessing the adequacy of decompression during LTIF. Methods: The 2 cases presented in this technical note illustrate resolution of s-EMG firing during LTIF, following distraction across the disk space. Removal of the distracting device produced the return of s-EMG firing. Both of these cases were operated at the L2-3 level. Results: In the first case, s-EMG firing was noted in the bilateral tibialis anterior leads. Resolution of EMG firing may suggest indirect decompression of the canal via ligamentotaxis as the L5 root traverses the L2-3 disk space. In the second case, s-EMG firing was noted in the left abductor hallucis and resolved with distraction of the L2-3 disk space. Again, this may be explained by canal decompression via ligamentotaxis as the S1 root traverses the L2-3 disk space. Conclusion: In both cases, distraction across the disk space resulted in resolution of s-EMG discharges-this correlated with an improvement in symptoms. These findings may suggest a role for s-EMG as a marker for adequacy of decompression in a select subset of patients undergoing LTIF. Further study is needed to determine if resolution of s-EMG is a useful measure of indirect decompression during LTIF.

Original languageEnglish (US)
JournalInternational Journal of Spine Surgery
Volume7
Issue number1
DOIs
StatePublished - Dec 1 2013

Fingerprint

Electromyography
Decompression
Pathologic Constriction
Spine
Device Removal
Neural Tube
Spinal Canal

Keywords

  • DLIF
  • Indirect decompression
  • LLIF
  • LTIF
  • Transpsoas
  • XLIF

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Technical note : Resolution of spontaneous electromyographic discharge following disk-space distraction during lateral transpsoas interbody fusion. / Woodall, Michael Neil; Shakir, Basheer; Smitherman, Adam; Choudhri, Haroon F.

In: International Journal of Spine Surgery, Vol. 7, No. 1, 01.12.2013.

Research output: Contribution to journalArticle

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abstract = "Purpose: The lateral transpsoas interbody fusion (LTIF) is an increasingly popular minimally invasive technique for lumbar interbody fusion. Although a posterior approach to the lumbar spine has traditionally been favored for the treatment of canal stenosis and neural foraminal stenosis, a growing body of evidence suggests that indirect decompression of the spinal canal and neural foramen can be achieved using a lateral transpsoas approach to the lumbar spine. We present 2 cases that may suggest a role for spontaneous electromyography (s-EMG) monitoring in assessing the adequacy of decompression during LTIF. Methods: The 2 cases presented in this technical note illustrate resolution of s-EMG firing during LTIF, following distraction across the disk space. Removal of the distracting device produced the return of s-EMG firing. Both of these cases were operated at the L2-3 level. Results: In the first case, s-EMG firing was noted in the bilateral tibialis anterior leads. Resolution of EMG firing may suggest indirect decompression of the canal via ligamentotaxis as the L5 root traverses the L2-3 disk space. In the second case, s-EMG firing was noted in the left abductor hallucis and resolved with distraction of the L2-3 disk space. Again, this may be explained by canal decompression via ligamentotaxis as the S1 root traverses the L2-3 disk space. Conclusion: In both cases, distraction across the disk space resulted in resolution of s-EMG discharges-this correlated with an improvement in symptoms. These findings may suggest a role for s-EMG as a marker for adequacy of decompression in a select subset of patients undergoing LTIF. Further study is needed to determine if resolution of s-EMG is a useful measure of indirect decompression during LTIF.",
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