Local tissue electrical resistances in transpedicular screw application in thoracolumbar region

摘要

tromyography, surgical navigation, and robotic surgery However, each technique has its own advantages and disadvantages. None of the techniques is simple enough and adequate on its own. Advanced techniques such as neuronavigation and fluoronavigation may be performed only in a few centers since they are both too costly and impractical although they minimize complication rates. Therefore, anteroposterior (AP) and lateral fluoroscopic imaging are currently the most commonly used complementary methods for transpedicular screw application. Transpedicular screw malposition remains a serious problem INTRODUCTION T ranspedicular screw application has an important place in common spinal operations. Inadvertent perforation of the wall of the vertebral pedicle is a well-known complication associated with standard pedicle screw insertion procedure. Despite varying rates by detection criteria, it has been reported that more than 25% of screws are malpositioned Malpositioned screws may have serious clinical consequences from dysesthesia to paraplegia (although rare) Many techniques have been defined for this purpose, including somatosensorial evoked potentials, elec-AIm: To determine local tissue electrical resistance differences generated during a screw pass from the pedicle to another tissue rather than determining all individual electrical tissue resistance values. mATERIAl and mEThODS: We attempted to measure electrical resistance values of regional tissues in addition to fluoroscopic imaging during application of fixation via a transpedicular screw. We also attempted to detect local tissue electrical resistance alterations in case of malposition of the screw inside the pedicle. For this purpose, local tissue electrical resistances of 10 transpedicular tracks opened with standard track openers bilaterally in 5 vertebrae, and of spinal cord accessed by puncturing the medial walls of three vertebrae in a cadaver were measured. These resistance differences were not only measured in human cadaveric tissue but also in 36 pedicles belonging to a total of 18 vertebrae between Th 1-S1 vertebrae of a sheep cadaver. Both medial and lateral walls were drilled to measure local tissue resistance differences in a sheep cadaver.