title: Electromyography monitoring for percutaneous placement of iliosacral screws.
abstract: OBJECTIVE
  To report our experience with the use of continuous electromyography (EMG) for placement of iliosacral screws.
  
  
  METHODS
  Concurrently acquired data as well as patient charts, intraoperative EMG records, x-rays, and pelvic computed tomography (CT) scans.
  
  
  METHODS
  The monitored group of twenty-nine patients was studied prospectively. The control group consisted of twenty-two patients studied retrospectively.
  
  
  METHODS
  Level One trauma center.
  
  
  METHODS
  Continuous electromyograms were recorded for twenty-nine patients and compared with those from a group of twenty-two antecedent patients who were not monitored. The primary parameter of interest of this study was the presence or absence of neurologic change after iliosacral screw placement. This information was obtained prospectively in the study group and by retrospective review in the historical control.
  
  
  RESULTS
  Four patients in the control group had postoperative and/or sensory motor changes prompting a postoperative CT scan; in each of these patients, a misdirected screw was identified and subsequently removed in a second procedure. There were no neurologic changes subsequent to placement in the twenty-nine patients who were monitored (7.5 percent versus 0 percent; p = 0.029, Fisher's exact test). All monitored patients had postoperative CT scans and showed the screw in a safe position with no significant violations of the S1 tunnel.
  
  
  CONCLUSIONS
  Continuous EMG monitoring during iliosacral screw placement may be a useful neuroprotective tool.
authors.affiliation: Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1070, USA.
authors.forename: L X
authors.initials: LX
authors.lastname: Webb
authors.forename: W
authors.initials: W
authors.lastname: de Araujo
authors.forename: P
authors.initials: P
authors.lastname: Donofrio
authors.forename: C
authors.initials: C
authors.lastname: Santos
authors.forename: F O
authors.initials: FO
authors.lastname: Walker
authors.forename: M A
authors.initials: MA
authors.lastname: Olympio
authors.forename: T
authors.initials: T
authors.lastname: Haygood
mesh_terms: D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D004576:Electromyography; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010384:Pelvic Bones / Q000293:injuries*; D011446:Prospective Studies