PDF(Pubmed)
Abstract：
Posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) are common modes of operative treatment of lumbar radiculopathy and spondylolisthesis. An integral part of these procedures is the appropriate placement of pedicle screws to ensure proper fusion. Breach of the medial cortex during pedicle screw fixation can potentially cause permanent impairment for a patient; significant technology and resources have been universally devoted to preventing this complication. Intraoperative neuromonitoring (IONM) is a frequently used tool by spine surgeons, which, along with fluoroscopy, is traditionally thought to reduce the incidence of neurologic injury. Unfortunately, IONM is not infallible and, in certain studies, has not been shown to decrease the risk of neurologic compromise. This case presentation details the clinical course of a 55-year-old who underwent an L4-5 TLIF. Despite benign electromyography recordings intraoperatively, the patient presented postoperatively with a new-onset left foot drop and a CT scan that confirmed bilateral L4 screw malposition with a breach of the medial cortex. We hope to further advance the discussion regarding the dangerous inconsistency of IONM in hopes of identifying a multimodal approach to avoid dreaded complications like this one in the future.
摘要：
后路腰椎椎间融合术（PLIF）和经椎间孔腰椎椎间融合术（TLIF）是腰椎神经根病和腰椎滑脱的常见手术治疗方式。这些程序的组成部分是椎弓根螺钉的适当放置，以确保正确的融合。椎弓根螺钉固定过程中内侧皮质的破裂可能会对患者造成永久性损害；大量技术和资源已普遍致力于预防这种并发症。术中神经监测（IONM）是脊柱外科医生经常使用的工具，which,随着透视，传统上被认为可以减少神经损伤的发生率。不幸的是,IONM并非万无一失，在某些研究中,没有显示可以降低神经系统损害的风险。此病例介绍详细介绍了一名55岁接受L4-5TLIF的临床过程。尽管术中记录了良性的肌电图，患者术后出现新发左足下垂,CT扫描证实双侧L4螺钉错位,内侧皮质破裂.我们希望进一步推进关于IONM危险的不一致问题的讨论，以期确定一种多式联运方法，以避免将来出现这种可怕的并发症。
