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Resumen: Introducción: La instrumentación con tornillos pediculares (TP) puede comprometer las estructuras neurales adyacentes. La electromiografía evocada (tEMG) es una modalidad del neuromonitoreo intraoperatorio utilizada para asistir la colocación de estos. El objetivo del presente estudio es evaluar la confiabilidad de esta herramienta. Método: Revisión retrospectiva de pacientes intervenidos de artrodesis lumbar posterolateral instrumentada desde enero del 2017 hasta diciembre del 2019. Se correlacionaron las imágenes de TC postoperatorias (TC-postop) con los resultados de la tEMG para cada TP con un umbral de 10 mA, y se establecieron la sensibilidad y especificidad de esta herramienta. Se realizó test diagnóstico y la curva característica operativa del receptor para evaluar el área bajo la curva. Resultado: Se evaluaron 275 TP entre L1 y S1; 5 TP presentaban concordancia para una trayectoria inadecuada, mientras que 10 TP, con tEMG

Introduction: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool. Method: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10 mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve. Result: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10 PS, with tEMG

Introduction: Instrumentation with pedicle screws (PS) can compromise the adjacent neural structures. Triggered electromyography (tEMG) is a modality of intraoperative neuromonitoring, used to assist in the placement of these. The objective of the present study is to evaluate the reliability of this tool., Method: Retrospective review of patients underwent posterior lumbar fusions from January 2017 to December 2019, correlating postoperative CT images (postop CT) with tEMG results for each PS with a threshold of 10mA, establishing sensitivity and specificity of this tool. Diagnostic test and receiver operating characteristic curve were performed to evaluate the area under the curve., Result: A total of 275 PS were evaluated between L1 to S1; 5 PS showed concordance for an inadequate trajectory, while 10PS, with tEMG <10mA, were correctly positioned. The postoperative CT identified 17 pedicle gaps not noticed by the tEMG. Sensitivity and specificity were 23% (95% CI: 8-45) and 96% (95% CI: 93-98), respectively, with a PPV of 33.3% and a NPV of 93.6%. The area under the curve was 0.74 (95% CI: 0.62-0.86) with a cut-off point of 24mA, showing a sensitivity of 77% (95% CI: 0.55-0.92) and specificity of 69% (95% CI: 0.63-0.75)., Conclusion: Given its low sensitivity, we do not recommend tEMG as the sole test in the verification of PS. We recommend using a cut-off point ≤8mA as it demonstrated the highest levels of sensitivity and specificity. We do not recommend using high thresholds to increase sensitivity., (Copyright © 2021 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.)