Electrical stimulation threshold in chronically compressed lumbar nerve roots: Observational study

Abstract

Objectives: Intraoperative neuromonitoring (IONM) is a common practice in spinal surgery, mostly during pedicle screw placement. However, there is not enough information about the factors that can interfere with IONM data. One of these factors may be existing damage of the nerve root whose function must be preserved. The main purpose of the present study is to evaluate the effect of chronic compression in lumbar nerve roots in terms of stimulation thresholds during direct nerve stimulation.

Patients and methods: Direct electrical stimulation was performed in 201 lumbar nerve roots during lumbar spinal procedures under general anaesthesia in 80 patients with different lumbar spinal pathologies. Clinical and radiological data were reviewed in order to establish the presence of chronic compression.

Results: Chronically compressed nerve roots showed a higher stimulation threshold than non compressed nerve roots (11.93 mA vs. 4.33 mA). This difference was confirmed with intra-subject comparison (paired sample t test, p=0.012). No other clinical factors were associated with this higher stimulation threshold in lumbar nerve roots.

Conclusion: A higher stimulation threshold is present in compressed lumbar nerve roots than non compressed roots. This needs to be taken into consideration during pedicle screw placement, where intraoperative neurophysiological monitoring is being used.

Keywords: Direct stimulation; Intraoperative neuromonitoring; Nerve compression; Nerve damage; Nerve root; Spinal surgery.