Περίληψη:
Background: In conus medullaris and cauda equina surgery, identification of the sacral nerve roots may be uncertain in spite of their anatomical/radiological landmarks. Mapping the sacral roots by recording the muscular responses to their stimulation may benefit from EMG recording of the External Anal sphincter (EAS) in addition to the main muscular groups of the lower limbs. Method: In a consecutive series of 27 lumbosacral dorsal rhizotomy (DRh), authors carried out a prospective study on the reliability of the EMG recording of the EAS for identification of the S1 and S2 sacral roots. Results: An EAS-response was recorded in all the 27 (bilaterally) explored individuals, testifying good sensitivity and selectivity of the method. EAS-responses were obtained in 96.3% of the 54 stimulated sides of the S2 root versus in only 16.66% for the S1 root, so that an absence of response would indicate S1 rather than S2 level. Furthermore, comparison between myotomal distribution of the S1 and S2 roots showed a significant difference (p < 0.00001), so that myotomal profile may help to identify root level. Conclusions: EMG recording of the EAS can be recommended for current intraoperative neuromonitoring. This simple method also provides—indirectly by extrapolation—information on the sacral motor pathways of the external urethral sphincter (EUS), as the later has the same somatic innervation via the pudendal nerve and related S2, S3, and S4 roots. Method can be helpful not only for DRh, of all varieties, but also for spine surgery, correction of dysraphisms, lipomas and/or tethered cord, and tumor resection. © 2020, Springer-Verlag GmbH Austria, part of Springer Nature.
Συγγραφείς:
Sindou, M.
Joud, A.
Georgoulis, G.
Λέξεις-κλειδιά:
antiinfective agent; botulinum toxin, adolescent; anus sphincter; Article; bladder sphincter; cerebral palsy; child; clinical article; dorsal rhizotomy; electromyography; female; human; innervation; intraoperative neurophysiological monitoring; male; myotome; nerve root; neural tube defect; priority journal; prospective study; pudendal nerve; quadriplegia; reliability; sensitivity and specificity; spasticity; spinal lipoma; spine surgery; spine tumor; stimulus response; surgical approach; tethered cord syndrome; anal canal; cauda equina; electromyography; intraoperative neurophysiological monitoring; lumbosacral region; pathophysiology; preschool child; procedures; reproducibility; rhizotomy; sacrum; spinal cord; surgery, Adolescent; Anal Canal; Cauda Equina; Child; Child, Preschool; Electromyography; Female; Humans; Intraoperative Neurophysiological Monitoring; Lumbosacral Region; Male; Prospective Studies; Reproducibility of Results; Rhizotomy; Sacrum; Sensitivity and Specificity; Spinal Cord
