title: The Use of Intraoperative Electromyogram During Spinal Cord Stimulator Placement Surgery: A Case Series.
abstract: BACKGROUND
  Spinal cord stimulation (SCS) is an efficacious treatment for various chronic pain syndromes culminating predominantly into spinal nerves. To improve intraoperative electrode placement, several groups have advocated the use of intraoperative neuromonitoring for localization of the spinal cord midline. In our study we present the case series of patients undergoing stimulator placement with consistent electromyographic intraoperative testing, with an emphasis on examining reoperation rates and complications.
  
  
  METHODS
  After approval from the institutional review board, we retrospectively collected data on standard demographics, preoperative diagnoses, prior spine surgeries, electrode manufacturer, blood loss, complications, and patient outcome.
  
  
  RESULTS
  The study included 103 patients with an average age of 60.7 years. Of these, 72 (69.9%) had prior spine surgery, which was associated with higher rate of reoperation (P = 0.019). The mean latency between initial SCS implantation and revision surgery ± SD was 14.6 ± 17.2 months, with a median time of 280 days. There was a 13.6% complication rate. Common complications that lead to reoperation included migrated electrode or failed generator.
  
  
  CONCLUSIONS
  Our retrospective chart review of 103 patients indicates that patients receiving SCS implantation in conjunction with electromyographic monitoring have low complication rates and rarely return to the operating room for electrode repositioning or removal.
authors.affiliation: Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Schoen
authors.affiliation: Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Lee Onn
authors.initials: LO
authors.lastname: Chieng
authors.affiliation: Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: drkarthik19@gmail.com.
authors.forename: Karthik
authors.initials: K
authors.lastname: Madhavan
authors.affiliation: Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Jermakowicz
authors.affiliation: Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Vanni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000453:epidemiology / Q000601:surgery; D004576:Electromyography / Q000379:methods; D004868:Equipment Failure; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D058542:Implantable Neurostimulators; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013116:Spinal Cord / Q000601:surgery*; D062187:Spinal Cord Stimulation
keywords: Chronic pain; Electromyogram; Failed back surgery syndrome; Spinal cord stimulation