A practical method for real-time detection of pedicle wall breaching during funneling

Area of Science:

• Spine Surgery
• Neurosurgery
• Surgical Navigation

Background:

• Detecting pedicle wall breaching during spine deformity surgery is crucial for patient safety.
• A real-time, accessible method for intraoperative detection is needed.

Purpose of the Study:

• To evaluate the sensitivity and specificity of a novel finder stimulation technique for detecting pedicle wall breaches during funnelling in spine deformity surgery.
• To compare the efficacy of this technique with traditional methods.

Main Methods:

• A study group of 56 patients (1066 pedicles) underwent continuous finder stimulation during funnelling, determining compound muscle action potential (CMAP) thresholds.
• A control group of 13 patients (226 pedicles) did not undergo finder stimulation.
• CMAP thresholds were compared with manual inspection of pedicular walls to assess sensitivity and specificity for breach detection.

Main Results:

• Receiver operating characteristic (ROC) analysis indicated a 9 mA cut-off with 88.0% sensitivity and 89.5% specificity for predicting pedicular breaching (AUC=0.92).
• Medial breaches showed significantly lower stimulation thresholds than lateral breaches.
• Screw-testing results were significantly better in the study group using finder stimulation compared to the control group.

Conclusions:

• Finder stimulation demonstrates high sensitivity and specificity for predicting pedicular breaching, particularly medial breaches.
• The technique enhances screw placement accuracy and offers high safety and low cost.
• This method is a valuable tool for spine deformity surgery, especially in resource-limited settings.