Safety and Feasibility of Transabdominal Muscle Action Potential Monitoring in Lateral Lumbar Surgery
Bibliographic record
Abstract
BACKGROUND: Neuromonitoring has improved since its advent in the 20th century, but technological innovations can potentially become furthermore specific and perform advanced analyses to prevent nerve injury. PURPOSE: To assess the viability of a novel intraoperative neuromonitoring modality - transabdominal muscle action potential monitoring (TMAP) - to provide reliable monitoring of the cauda equina during lumbar spinal fusion. METHODS: This was a multicenter, prospective, single-cohort, technical feasibility study. A total of 296 patients who underwent one- or two-level lateral lumbar interbody fusion with TMAP neuromonitoring in the treatment of degenerative lumbar spinal disease were enrolled and analyzed. Lateral lumbar interbody fusion was performed at L4-L5 in all patients and at additional levels when needed. Triggered electromyography was utilized, per the surgical technique, to map the transpsoas surgical corridor. Additionally, TMAP was used to monitor bilateral lower extremity nerve function before, during, and at the end of surgery. The feasibility of TMAP to stimulate lower extremity myotomes was measured at baseline and through the procedure. RESULTS: In 296 patients included for final analysis, 98.9% of myotomes were activated at baseline and 98.6% of myotomes activated at closure. At least three myotomes were activated in all patients before and after surgery. All 10 myotomes were activated in 94% of patients at baseline and in 93% at closure. CONCLUSIONS: TMAP during lumbar spine surgery is feasible and safe for patients being treated for lumbar degenerative disease, while avoiding some of the drawbacks of transcranial motor evoked potentials. Additional studies are needed to assess clinical correlation between TMAP monitoring and patient outcome.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".