The discrepancy in triggered electromyography responses between fatty filum and normal filum terminale
Abstract Background Functional role of filum terminale (FT) was not well studied though it contains structure basis for nerve impulse conduction. We aimed to explore the possible functions of the FT from the perspective of triggered electromyography (EMG) during surgery. Methods We retrospectively r...
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| Format: | Article |
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BMC
2024-02-01
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| Series: | BMC Surgery |
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| Online Access: | https://doi.org/10.1186/s12893-024-02351-0 |
| _version_ | 1797276060677570560 |
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| author | Yizi Cai Rui Wang Junlu Wang Qijia Zhan Min Wei Bo Xiao Qiang Wang Wenbin Jiang |
| author_facet | Yizi Cai Rui Wang Junlu Wang Qijia Zhan Min Wei Bo Xiao Qiang Wang Wenbin Jiang |
| author_sort | Yizi Cai |
| collection | DOAJ |
| description | Abstract Background Functional role of filum terminale (FT) was not well studied though it contains structure basis for nerve impulse conduction. We aimed to explore the possible functions of the FT from the perspective of triggered electromyography (EMG) during surgery. Methods We retrospectively reviewed intraoperative neurophysiological monitoring data from pediatric patients who underwent intradural surgeries at the lumbar level in Shanghai Children’s. Hospital from January 2018 to March 2023. Altogether 168 cases with complete intraoperative neurophysiological recordings of the FT were selected for further analysis. Triggered EMG recordings of the filum originated from two main types of surgeries: selective dorsal rhizotomy (SDR) and fatty filum transection. Results 96 cases underwent SDR and 72 cases underwent fatty filum transection. Electrical stimulation of the FT with fatty infiltration did not elicit electromyographic activity in the monitored muscles with the maximum stimulus intensity of 4.0 mA, while the average threshold for FT with normal appearance was 0.68 mA, and 89 out of 91 FT could elicit electromyographic responses in monitored channels. The threshold ratio of filum to motor nerve roots at the same surgical segment was significantly higher in patients with fatty filum, and a cut-off point of 21.03 yielded an area under curve of 0.943, with 100% sensitivity and 85.71% specificity. Conclusion Filum with normal appearance can elicit electromyographic activity in the lower limbs/anal sphincter similar to the performance of the cauda equina nerve roots. The threshold of fatty filum is different from that of normal appearing FT. Triggered EMG plays an important role in untethering surgeries. |
| first_indexed | 2024-03-07T15:22:55Z |
| format | Article |
| id | doaj.art-64a985267b2b425ba7ec70e4b29ab4b4 |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-03-07T15:22:55Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-64a985267b2b425ba7ec70e4b29ab4b42024-03-05T17:30:44ZengBMCBMC Surgery1471-24822024-02-012411910.1186/s12893-024-02351-0The discrepancy in triggered electromyography responses between fatty filum and normal filum terminaleYizi Cai0Rui Wang1Junlu Wang2Qijia Zhan3Min Wei4Bo Xiao5Qiang Wang6Wenbin Jiang7Department of Neonatology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong UniversityDepartment of Neurosurgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong UniversityCollege of Computer and Network Engineering, Shanxi Datong UniversityDepartment of Neurosurgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong UniversityAbstract Background Functional role of filum terminale (FT) was not well studied though it contains structure basis for nerve impulse conduction. We aimed to explore the possible functions of the FT from the perspective of triggered electromyography (EMG) during surgery. Methods We retrospectively reviewed intraoperative neurophysiological monitoring data from pediatric patients who underwent intradural surgeries at the lumbar level in Shanghai Children’s. Hospital from January 2018 to March 2023. Altogether 168 cases with complete intraoperative neurophysiological recordings of the FT were selected for further analysis. Triggered EMG recordings of the filum originated from two main types of surgeries: selective dorsal rhizotomy (SDR) and fatty filum transection. Results 96 cases underwent SDR and 72 cases underwent fatty filum transection. Electrical stimulation of the FT with fatty infiltration did not elicit electromyographic activity in the monitored muscles with the maximum stimulus intensity of 4.0 mA, while the average threshold for FT with normal appearance was 0.68 mA, and 89 out of 91 FT could elicit electromyographic responses in monitored channels. The threshold ratio of filum to motor nerve roots at the same surgical segment was significantly higher in patients with fatty filum, and a cut-off point of 21.03 yielded an area under curve of 0.943, with 100% sensitivity and 85.71% specificity. Conclusion Filum with normal appearance can elicit electromyographic activity in the lower limbs/anal sphincter similar to the performance of the cauda equina nerve roots. The threshold of fatty filum is different from that of normal appearing FT. Triggered EMG plays an important role in untethering surgeries.https://doi.org/10.1186/s12893-024-02351-0Filum terminaleElectrophysiologyElectromyographyIntraoperative neurophysiological monitoring |
| spellingShingle | Yizi Cai Rui Wang Junlu Wang Qijia Zhan Min Wei Bo Xiao Qiang Wang Wenbin Jiang The discrepancy in triggered electromyography responses between fatty filum and normal filum terminale BMC Surgery Filum terminale Electrophysiology Electromyography Intraoperative neurophysiological monitoring |
| title | The discrepancy in triggered electromyography responses between fatty filum and normal filum terminale |
| title_full | The discrepancy in triggered electromyography responses between fatty filum and normal filum terminale |
| title_fullStr | The discrepancy in triggered electromyography responses between fatty filum and normal filum terminale |
| title_full_unstemmed | The discrepancy in triggered electromyography responses between fatty filum and normal filum terminale |
| title_short | The discrepancy in triggered electromyography responses between fatty filum and normal filum terminale |
| title_sort | discrepancy in triggered electromyography responses between fatty filum and normal filum terminale |
| topic | Filum terminale Electrophysiology Electromyography Intraoperative neurophysiological monitoring |
| url | https://doi.org/10.1186/s12893-024-02351-0 |
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