Prevention of spinal cord injury during thoracic spine surgery

胸椎手术中脊髓损伤的预防

• 批准号: 8105036
• 负责人: Blair Calancie
• 金额: $ 26.93万
• 依托单位: UPSTATE MEDICAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8105036
• 关键词: Back; Bone Screws; Chest; Deformity; Feedback; Frequencies; Gender; Goals; Health; Human; Image; Implant; Incidence; Injury; Intervention; Lead; Left; Location; Lower Extremity; Medial; Metals; Methods; Monitor; Muscle; Neurostimulation procedures of spinal cord tissue; Operative Surgical Procedures; Outcome Measure; Patients; Pattern; Physiologic pulse; Positioning Attribute; Postoperative Period; Prevention; Property; Protocols documentation; Randomized; Relative (related person); Risk; Site; Spinal; Spinal Canal; Spinal Cord; Spinal cord injury; Spinal nerve root structure; Staging; Stimulus; Study Subject; Surgeon; Symptoms; Testing; Time; Tissues; Training; Trauma; Vertebral column; X-Ray Computed Tomography; arm; base; bone; cohort; high risk; implantation; improved; information gathering; innovation; instrumentation; novel; operation; prevent; prospective; relating to nervous system; response; retinal rods; spine bone structure

DESCRIPTION (provided by applicant): Surgery involving the thoracic spine sometimes requires the implantation of metal rods to stabilize and fuse the vertebrae. One increasingly-popular method of anchoring these rods is to place large bone screws through the pedicles that connect the `back' part of each vertebra (i.e. the lamina) with its `front' part (i.e. the body), and then connecting the rods to these implanted screws. Typically a narrow `awl' (or pedicle finder) is forced through the pedicle (creating the pedicle track), and then a screw is placed along this track. Ideally the screw should be fully- contained within bone, but if it `misses' towards the midline (i.e. medially) at any level within the thoracic spine, it may hit and injure the spinal cord. The goal of this study is to develop a new intra-operative monitoring (IOM) test of spinal cord conduction to prevent medial malplacement of thoracic pedicle screws, thereby preventing spinal cord injury. In the first of 2 Specific Aims, we will establish the relationship between the amount of energy needed to electrically stimulate spinal cord and nerve roots through the pedicle track (i.e. prior to screw implantation) and the position of that screw relative to the pedicle, once the screw is placed. We anticipate that pedicle tracks which have broken through the bone of the medial pedicle wall will lead to spinal cord stimulation with weak current intensities. We will retrospectively develop rules to tell us when it is safe to put a screw in a particular pedicle track. In Specific Aim #2, we will apply these rules in a prospective manner to actively prevent screw malplacement during surgery in new subjects. Moreover, we will randomize these subjects into two cohorts. In one group we will actively stimulate through a modified pedicle finder while the surgeon is making a pedicle track, to provide immediate feedback to the surgeon if the orientation of the pedicle track needs to change. We anticipate that there will be fewer cases of medially-malplaced thoracic pedicle screws in subjects studied in Specific Aim #2 compared to those tested with the protocol from Specific Aim #1. Moreover we expect that those subjects who receive active stimulation through the pedicle finder will have the lowest incidence of medial screw malplacement of all subjects tested. By the end of this study period, we will have developed and validated a novel form of intra- operative monitoring for thoracic pedicle screw placement. Not only will this test lower the risk of spinal cord injury, but it will also lower the numbers of subjects who require additional surgery to revise screw placements that " while not causing spinal cord injury per se" are still encroaching upon the canal space enough that they would eventually lead to symptoms if left in place. PUBLIC HEALTH RELEVANCE: Surgery to the thoracic spine to treat deformity or trauma places the spinal cord at relatively high risk for injury, particularly when screws are implanted into the pedicles of the spine. This project will develop a novel method to prevent accidental screw placement into the spinal cord, thereby preventing spinal cord injury.

描述（由申请人提供）：涉及胸椎的手术有时需要植入金属棒才能稳定和融合椎骨。固定这些杆的一种日益受欢迎的方法是将大骨螺钉穿过连接每个椎骨的“背部”部分（即薄片）及其“前”部分（即身体），然后将杆连接到这些植入的螺钉。通常，狭窄的“锥子”（或椎弓根查找器）被强迫通过椎弓根（创建椎弓根轨道），然后沿着该轨道放置螺钉。理想情况下，应将螺钉完全包含在骨骼内，但是如果螺钉“错过”朝向中线（即在胸椎内的任何水平上），则可能会击中并伤害脊髓。这项研究的目的是开发脊髓传导的新术中监测（IOM）测试，以防止胸椎螺钉内侧故障，从而防止脊髓损伤。在两个特定目标中的第一个中，我们将建立通过椎弓根轨道（即螺钉植入之前）电气刺激脊髓和神经根所需的能量之间的关系，一旦放置螺钉，该螺钉相对于椎弓根的位置。我们预计，通过内侧椎弓根壁的骨头损坏的椎弓根轨道将导致脊髓刺激，并且电流强度较弱。我们将回顾性地制定规则，以告诉我们何时可以安全地将螺钉放在特定的椎弓根轨道上。在特定的目标＃2中，我们将以前瞻性的方式应用这些规则，以在新受试者的手术过程中积极防止螺丝损伤。此外，我们将将这些受试者随机分为两个队列。在一个组中，我们将在外科医生制作椎弓根轨道时通过改良的椎弓根查找器积极刺激，如果椎弓根轨道的方向需要改变，则可以立即向外科医生提供反馈。我们预计，与特定AIM＃1的协议测试的受试者相比，在特定AIM 2中研究的受试者中的内侧胸椎螺钉将较少。此外，我们期望那些通过椎弓根发现器进行主动刺激的受试者将对所有测试的受试者的内侧螺钉故障发病率最低。到本研究期结束时，我们将开发并验证了一种新型的胸部椎弓根螺钉内手术内监测形式。该测试不仅会降低脊髓损伤的风险，而且还将降低需要进行额外手术的受试者数量修改螺钉放置，这些螺钉放置“虽然不会造成脊髓损伤本身”，但仍在足够侵占运河空间，以至于如果留下来，他们最终会导致症状。公共卫生相关性：胸部脊柱的手术以治疗畸形或创伤使脊髓处于受伤的风险相对较高的风险，尤其是在将螺钉植入脊柱的椎弓根时。该项目将开发一种新的方法，以防止意外的螺丝置入脊髓中，从而防止脊髓损伤。

项目成果

Is in vivo manual palpation for thoracic pedicle screw instrumentation reliable?

• DOI: 10.3171/2014.1.spine13197
• 发表时间: 2014-05-01
• 期刊: JOURNAL OF NEUROSURGERY-SPINE
• 影响因子: 2.8
• 作者: Donohue, Miriam L.;Moquin, Ross R.;Calancie, Blair
• 通讯作者: Calancie, Blair

Neuromonitoring with pulse-train stimulation for implantation of thoracic pedicle screws: a blinded and randomized clinical study. Part 1. Methods and alarm criteria.

使用脉冲序列刺激进行胸椎椎弓根螺钉植入的神经监测：一项盲法随机临床研究。

• DOI: 10.3171/2014.2.spine13648
• 发表时间: 2014
• 期刊: Journal of neurosurgery. Spine
• 作者: Calancie,Blair;Donohue,MiriamL;Harris,ColinB;Canute,GregoryW;Singla,Amit;Wilcoxen,KaitlinG;Moquin,RossR
• 通讯作者: Moquin,RossR