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Usefulness of external anal sphincter EMG recording for intraoperative neuromonitoring of the sacral roots—a prospective study in dorsal rhizotomy

  • Original Article - Neurosurgical Anatomy
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Abstract

Background

In conus medullaris and cauda equina surgery, identification of the sacral nerve roots may be uncertain in spite of their anatomical/radiological landmarks. Mapping the sacral roots by recording the muscular responses to their stimulation may benefit from EMG recording of the External Anal sphincter (EAS) in addition to the main muscular groups of the lower limbs.

Method

In a consecutive series of 27 lumbosacral dorsal rhizotomy (DRh), authors carried out a prospective study on the reliability of the EMG recording of the EAS for identification of the S1 and S2 sacral roots.

Results

An EAS-response was recorded in all the 27 (bilaterally) explored individuals, testifying good sensitivity and selectivity of the method. EAS-responses were obtained in 96.3% of the 54 stimulated sides of the S2 root versus in only 16.66% for the S1 root, so that an absence of response would indicate S1 rather than S2 level. Furthermore, comparison between myotomal distribution of the S1 and S2 roots showed a significant difference (p < 0.00001), so that myotomal profile may help to identify root level.

Conclusions

EMG recording of the EAS can be recommended for current intraoperative neuromonitoring. This simple method also provides—indirectly by extrapolation—information on the sacral motor pathways of the external urethral sphincter (EUS), as the later has the same somatic innervation via the pudendal nerve and related S2, S3, and S4 roots. Method can be helpful not only for DRh, of all varieties, but also for spine surgery, correction of dysraphisms, lipomas and/or tethered cord, and tumor resection.

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Author information

Authors and Affiliations

  1. University of Lyon, Lyon, France

    Marc Sindou

  2. IRR Flavigny, UGECAM Nord-Est, Nancy, France

    Marc Sindou & Anthony Joud

  3. Pediatric Neurosurgery Department, CHRU Nancy, Nancy, France

    Marc Sindou & Anthony Joud

  4. Department of Neurosurgery, General Hospital of Athens “G.Gennimatas”, Mesogeion Avenue 154, 11527, Athens, Greece

    George Georgoulis

  5. Medical School, University of Athens, Athens, Greece

    George Georgoulis

Authors
  1. Marc Sindou
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  2. Anthony Joud
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Correspondence to George Georgoulis.

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Sindou, M., Joud, A. & Georgoulis, G. Usefulness of external anal sphincter EMG recording for intraoperative neuromonitoring of the sacral roots—a prospective study in dorsal rhizotomy. Acta Neurochir 163, 479–487 (2021). https://doi.org/10.1007/s00701-020-04610-4

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  • DOI: https://doi.org/10.1007/s00701-020-04610-4

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