AIM: The goal of intraoperative nerve root monitoring on the lumbosacral spine is to minimize the risk of nerve root injuries during surgery by reducing the incidence of misplaced pedicle screws. In this study we hypothesized that the INS-1 device (Nuvasive) may provide more accurate information about screw placement. METHOD: The INS-1 device provides a means for intraoperative EMG stimulation through the inside of the pedicles or the implanted screws. The readings from relevant muscles serve as a monitoring technique to detect perforated pedicles and thus can be used to prevent or detect misplaced pedicle screws and reduce the risk of nerve root injuries. We controlled 58 patients with 334 implanted pedicle screws. RESULTS: Our first experience with 334 pedicle screws shows that nerve root injuries can be avoided by reducing the number of misplaced pedicle screws through additional intraoperative information gained by the INS-1 device. Thus we corrected 3.9 % of screws intraoperatively in cases without relevant information from fluoroscopic control. CONCLUSION: The INS-1 device is a helpful tool to obtain additional information on misplaced pedicle drill holes or already implanted screws in the lumbosacral spine.

Adult↗

PubMedDate not supplied

Therapy of ankylosing spondylitis--a review. Part I: Conventional medical treatment and surgical therapy.

The main outcome parameters in AS and other SpA are pain, disease activity, function, spinal mobility, and structural progression. There are several treatment options, which differ, depending on the localization and severity of the manifestation and the degree of structural changes already present. There is a basic role for physiotherapy to improve and maintain spinal mobility and function and prevent handicap. The basis for drug therapy in AS is NSAIDs, which may also have an influence on structural progression. DMARDs are mainly used in cases with peripheral arthritis. Corticosteroids have a clear role for intra-articular therapy, while the role for systemic use is, in contrast to RA, mainly reserved for subgroups. It is largely unclear whether long-term spinal progression can be prevented by conventional drug therapy. Treatment with biologics such as anti-TNF-alpha therapy is discussed in Part 2 of this review. To be published in the next issue of the Scandinavian Journal of Rheumatology. Surgical treatment of the spine is indicated in cases of severe instability pain, in cases of deformity endangering the patient in daily life by the limited range of vision, and in patients with neurological deficiency. AS-specific problems are spinal fractures and atlantoaxial instability, which need careful management including surgery. Joint replacement therapy is established and beneficial for AS-disturbed joints of the hip and knee.

Antirheumatic Agents↗