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Electrical stimulation threshold in chronically compressed lumbar nerve roots: Observational study
Julio Plata-Bello1, Pedro Javier Pérez-Lorensu2, Liberto Brage1
1Hospital Universitario de Canarias, Department of Neurosurgery, S/C de Tenerife, Spain.
Clinical Neurology and Neurosurgery
|September 7, 2015
Summary
Chronic compression of lumbar nerve roots increases their stimulation threshold during intraoperative neuromonitoring (IONM). This finding is crucial for accurate IONM during spinal surgery, particularly pedicle screw placement.
Area of Science:
- Neurosurgery
- Spinal Surgery
- Neuromonitoring
Background:
- Intraoperative neuromonitoring (IONM) is vital during spinal surgery, especially for pedicle screw placement.
- Factors influencing IONM data accuracy require further investigation.
- Nerve root damage, such as chronic compression, may impact IONM signals.
Purpose of the Study:
- To assess the impact of chronic compression on lumbar nerve roots.
- To evaluate changes in stimulation thresholds during direct nerve stimulation in compressed versus non-compressed nerve roots.
Main Methods:
- Direct electrical stimulation was applied to 201 lumbar nerve roots in 80 patients undergoing spinal procedures.
- Patients had various lumbar spinal pathologies under general anesthesia.
- Clinical and radiological data were analyzed to identify chronic compression.
Main Results:
- Chronically compressed nerve roots exhibited significantly higher stimulation thresholds (11.93 mA) compared to non-compressed roots (4.33 mA).
- This difference was statistically significant (p=0.012) even within the same subject.
- No other clinical factors correlated with the elevated stimulation threshold.
Conclusions:
- Compressed lumbar nerve roots demonstrate a higher stimulation threshold.
- This heightened threshold must be considered during pedicle screw placement utilizing IONM.
- Adjusting IONM interpretation for nerve root compression can enhance surgical safety.
Keywords:
Direct stimulationIntraoperative neuromonitoringNerve compressionNerve damageNerve rootSpinal surgery
