We have located links that may give you full text access.
Evaluation Studies
Journal Article
The significance of anode location for stimulus-evoked electromyography during iliosacral screw placement.
Journal of Orthopaedic Trauma 2003 Februrary
OBJECTIVES: To determine the effect of anode location on the current threshold required to provoke an electromyograph response during stimulus-evoked electromyography for iliosacral screw placement.
DESIGN: Prospective cohort.
SETTING: Level I trauma center.
PATIENTS: Nineteen consecutive patients with 23 unstable posterior pelvic ring injuries treated with iliosacral screws.
INTERVENTION: Iliosacral screws were inserted percutaneously over guidewires. Twenty-seven screws were inserted, all into the first sacral vertebrae. The guidewire was used as the cathode for constant-current, stimulus-evoked electromyography for all data collection. Stimulus-evoked electromyographs were obtained with the guidewire at four different stations: at the sacroiliac joint (station I), at the first sacral neuroforamen (station II), in the body of the sacrum (station III), and when the iliosacral screw was in final position over the guidewire (station IV).
MAIN OUTCOME MEASURE: Stimulus-evoked electromyographs were obtained with the anode at four different locations for each of the implant stations. Location A had the anode adjacent to the percutaneous insertion site of the guidewire, location B at the ipsilateral anterior superior iliac spine, location C at the midline, and location D at the contralateral anterior superior iliac spine.
RESULTS: Moving the anode from midline (location C) toward the entry point of the guidewire increased the current threshold required to provoke an EMG response as much as 67.1% (p < 0.05). Moving the anode from midline to the contralateral anterior superior iliac spine decreased thresholds as much as 3.4% (p > 0.05). In one case, anode placement close to the guidewire insertion site (locations A and B) failed to identify a potentially dangerous implant because current thresholds were >8 mA. With the anode at the midline, current thresholds were <8 mA, indicating unsafe guidewire position leading to redirection of the guidewire.
CONCLUSION: The physical location of the anode during stimulus-evoked electromyography monitoring for iliosacral screw placement significantly changes the current thresholds required to provoke an electromyograph response. Current thresholds required to stimulate nerves increase as the anode is moved toward the stimulating electrode. Anode placement ipsilateral to the stimulating electrode may provide a false indication of safe guidewire placement. We recommend anode location at or beyond the midline for stimulus-evoked electromyography monitoring during iliosacral screw placement.
DESIGN: Prospective cohort.
SETTING: Level I trauma center.
PATIENTS: Nineteen consecutive patients with 23 unstable posterior pelvic ring injuries treated with iliosacral screws.
INTERVENTION: Iliosacral screws were inserted percutaneously over guidewires. Twenty-seven screws were inserted, all into the first sacral vertebrae. The guidewire was used as the cathode for constant-current, stimulus-evoked electromyography for all data collection. Stimulus-evoked electromyographs were obtained with the guidewire at four different stations: at the sacroiliac joint (station I), at the first sacral neuroforamen (station II), in the body of the sacrum (station III), and when the iliosacral screw was in final position over the guidewire (station IV).
MAIN OUTCOME MEASURE: Stimulus-evoked electromyographs were obtained with the anode at four different locations for each of the implant stations. Location A had the anode adjacent to the percutaneous insertion site of the guidewire, location B at the ipsilateral anterior superior iliac spine, location C at the midline, and location D at the contralateral anterior superior iliac spine.
RESULTS: Moving the anode from midline (location C) toward the entry point of the guidewire increased the current threshold required to provoke an EMG response as much as 67.1% (p < 0.05). Moving the anode from midline to the contralateral anterior superior iliac spine decreased thresholds as much as 3.4% (p > 0.05). In one case, anode placement close to the guidewire insertion site (locations A and B) failed to identify a potentially dangerous implant because current thresholds were >8 mA. With the anode at the midline, current thresholds were <8 mA, indicating unsafe guidewire position leading to redirection of the guidewire.
CONCLUSION: The physical location of the anode during stimulus-evoked electromyography monitoring for iliosacral screw placement significantly changes the current thresholds required to provoke an electromyograph response. Current thresholds required to stimulate nerves increase as the anode is moved toward the stimulating electrode. Anode placement ipsilateral to the stimulating electrode may provide a false indication of safe guidewire placement. We recommend anode location at or beyond the midline for stimulus-evoked electromyography monitoring during iliosacral screw placement.
Full text links
Related Resources
Trending Papers
Challenges in Septic Shock: From New Hemodynamics to Blood Purification Therapies.Journal of Personalized Medicine 2024 Februrary 4
Molecular Targets of Novel Therapeutics for Diabetic Kidney Disease: A New Era of Nephroprotection.International Journal of Molecular Sciences 2024 April 4
The 'Ten Commandments' for the 2023 European Society of Cardiology guidelines for the management of endocarditis.European Heart Journal 2024 April 18
A Guide to the Use of Vasopressors and Inotropes for Patients in Shock.Journal of Intensive Care Medicine 2024 April 14
Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.Circulation 2024 April 19
Essential thrombocythaemia: A contemporary approach with new drugs on the horizon.British Journal of Haematology 2024 April 9
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app