EVALUATION OF PEDICLE SCREW INSERTION MONITORED BY INTRAOPERATIVE EVOKED ELECTROMYOGRAPHY

The insertion of pedicle screws monitored by evoked electromyography ( EMG) was prospectively evaluated in the 132 consecutive patients. The technique involved constant-voltage stimulation and was statistically evaluated at both the arbitrary 20- and 40-V settings. The patients we re postoperatively evaluated clinically and radiographically. Computed tomography (CT) scanning was performed for new neurologic deficits. R esults were divided into three groups: type 1, a negative EMG response ; type 2, a positive EMG response, but no corrective action taken; and type 3, a positive EMG response and corrective action undertaken. Non parametric statistics were used to evaluate the results at both the 20 - and 40-V settings. In the type 3 group, in which corrective action w as undertaken, there were no neurologic injuries or screw removals, a statistically significant result. Looking at the two intensity levels, at 20- and 40-V settings, there were no statistically significant dif ferences in the three classifications at either intensity level. We co ncluded that evoked EMG for monitoring pedicle screw insertion is an e fficacious adjunct. A positive response at <20 V with the constant-vol tage technique warrants corrective action.