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A systematic review with meta-analysis of the diagnostic test accuracy of pedicle screw electrical stimulation

  • Review Article
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Abstract

Purpose

To provide a systematic review with meta-analysis providing evidence of the current diagnostic test accuracy (DTA) of pedicle screw electrical stimulation.

Methods

A systematic database search on PubMed, Scopus and Web of Science was performed according to the PRISMA-DTA guidelines, and eligibility criteria applied to reduce the results to: (1) only journal articles reporting electrical stimulation of the pedicle screw head, (2) screw position confirmation by imaging techniques, and (3) enough information allowing the calculation of a 2 × 2 contingency table. Sample characteristics, image confirmation method, electrical current threshold and stimulation results were retrieved and analyzed using according to appropriate DTA analysis methods, and allowing the calculation of specificity, sensitivity for pedicle screws insertion at the lumbar and thoracic levels.

Results

Lumbar screw stimulation presents a higher sensitivity (0.586 [0.336, 0.798] and specificity (0.984 [0.958, 0.994]) than thoracic screws (sensitivity: 0.270 [0.096; 0.562]; specificity: 0.958 [0.931, 0.975]). The same is observed in terms of the diagnostic odds ratio for lumbar (88.32 [32.136, 242.962]) and thoracic (8.460 [2.139, 33.469]) levels. When performing a sub-group analysis, it is possible to divide the lumbar stimulation threshold as 8 and 10–12 mA, and the thoracic threshold as 6 and 9–12 mA. A threshold of 8 mA at the lumbar level provides higher sensitivity and specificity. Increasing the threshold results in higher specificity but not sensitivity. In fact, at the range of 10–12 mA, the diagnostic validity is too low to confer this technique any robust diagnostic validity. Similarly, at the thoracic level, lower threshold currents are associated with increased sensitivity, but their diagnostic validity is very low.

Conclusion

Electrical stimulation of the pedicle screw can be used as an adequate diagnostic capability at the lumbar level with a threshold of 8 mA. However, thoracic stimulation is currently not reliable, with very low sensitivity and diagnostic validity at 6 mA or higher.

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Data Availability

This review study used data available from the searched databases.

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Acknowledgements

The authors would like to acknowledge the advisory contribution of Renato Andrade regarding the procedures required to perform a systematic review with meta-analysis.

Funding

The author Pedro Fonseca received financial support by Spine Implantes Brasil as tuition for the persecution of a PhD degree. Márcio Goethel is a partner of Scripibomer, a branch company of the aforementioned company. The remaining authors do not have any other financial interests.

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Authors and Affiliations

  1. LABIOMEP: Porto Biomechanics Laboratory, University of Porto, Porto, Portugal

    Pedro Fonseca, Márcio Goethel, João Paulo Vilas-Boas, Manuel Gutierres & Miguel Velhote Correia

  2. FEUP: Faculty of Engineering, University of Porto, Porto, Portugal

    Pedro Fonseca & Miguel Velhote Correia

  3. FADEUP: Faculty of Sports, University of Porto, Porto, Portugal

    João Paulo Vilas-Boas

  4. FMUP: Faculty of Medicine, University of Porto, Porto, Portugal

    Manuel Gutierres

  5. INESC TEC: Institute for Systems and Computer Engineering, Technology and Science, Porto, Portugal

    Miguel Velhote Correia

Authors
  1. Pedro Fonseca
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  2. Márcio Goethel
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  3. João Paulo Vilas-Boas
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  4. Manuel Gutierres
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  5. Miguel Velhote Correia
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Contributions

All authors contributed to the design and conceptualization of the review. P.F. performed the database search, application of PRISMA protocol, analysis of results and drafting of initial manuscript. M.G. performed analysis of results and drafting of the original manuscript. J.P.V.B, M.G. and M.V.C. provided a review of results, cooperated in the discussion and the conclusion, and participated in the writing of the article.

Corresponding author

Correspondence to Pedro Fonseca.

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All authors declare that they have no conflict of interest.

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This is a systematic review with meta-analysis, reflecting a bibliographic analysis of published work, and therefore does not require the approval of an Ethics Committee.

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Fonseca, P., Goethel, M., Vilas-Boas, J. et al. A systematic review with meta-analysis of the diagnostic test accuracy of pedicle screw electrical stimulation. Eur Spine J 31, 1599–1610 (2022). https://doi.org/10.1007/s00586-022-07218-7

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  • DOI: https://doi.org/10.1007/s00586-022-07218-7

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