{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:02:24Z","timestamp":1790085744847,"version":"4.0.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>The C7 vertebral body is morphometrically unique; it represents the transition from the subaxial cervical spine to the upper thoracic spine. It has larger pedicles but relatively small lateral masses compared to other levels of the subaxial cervical spine. Although the biomechanical properties of C7 pedicle screws are superior to those of lateral mass screws, they are rarely placed due to increased risk of neurological injury. Although pedicle screw stimulation has been shown to be safe and effective in determining satisfactory screw placement in the thoracolumbar spine, there are few studies determining its utility in the cervical spine. Thus, the purpose of this study was to determine the feasibility, clinical reliability, and threshold characteristics of intraoperative evoked electromyographic (EMG) stimulation in determining satisfactory pedicle screw placement at C7.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors retrospectively reviewed a prospectively collected data set. All adult patients who underwent posterior cervical decompression and fusion with placement of C7 pedicle screws at the authors\u2019 institution between January 2015 and March 2019 were identified. Demographic, clinical, neurophysiological, operative, and radiographic data were gathered. All patients underwent postoperative CT scanning, and the position of C7 pedicle screws was compared to intraoperative neurophysiological data.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Fifty-one consecutive C7 pedicle screws were stimulated and recorded intraoperatively in 25 consecutive patients. Based on EMG findings, 1 patient underwent intraoperative repositioning of a C7 pedicle screw, and 1 underwent removal of a C7 pedicle screw. CT scans demonstrated ideal placement of the C7 pedicle screw in 40 of 43 instances in which EMG stimulation thresholds were &gt; 15 mA. In the remaining 3 cases the trajectories were suboptimal but safe. When the screw stimulation thresholds were between 11 and 15 mA, 5 of 6 screws were suboptimal but safe, and in 1 instance was potentially dangerous. In instances in which the screw stimulated at thresholds \u2264 10 mA, all trajectories were potentially dangerous with neural compression.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Ideal C7 pedicle screw position strongly correlated with EMG stimulation thresholds &gt; 15 mA. In instances, in which the screw stimulates at values between 11 and 15 mA, screw trajectory exploration is recommended. Screws with thresholds \u2264 10 mA should always be explored, and possibly repositioned or removed. In conjunction with other techniques, EMG threshold testing is a useful and safe modality in determining appropriate C7 pedicle screw placement.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.11.spine191120","type":"journal-article","created":{"date-parts":[[2020,1,31]],"date-time":"2020-01-31T22:59:16Z","timestamp":1580511556000},"page":"891-899","source":"Crossref","is-referenced-by-count":6,"title":["Utility of intraoperative electromyography in placing C7 pedicle screws"],"prefix":"10.3171","volume":"32","author":[{"given":"Jonathan J.","family":"Rasouli","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai Health System, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brooke T.","family":"Kennamer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Missouri, Columbia, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank M.","family":"Moore","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai Health System, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Steinberger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai Health System, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin C.","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai Health System, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar N.","family":"Syed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai Health System, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc S.","family":"Arginteanu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai Health System, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakov","family":"Gologorsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mount Sinai Health System, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"405","DOI":"10.3171\/2010.11.SPINE09776","article-title":"Factors affecting lateral mass screw placement at C-7","volume":"14","author":"Abdullah KG","year":"2011","unstructured":"Abdullah KG, Nowacki AS, Steinmetz MP, Wang JC, Mroz TE: Factors affecting lateral mass screw placement at C-7. 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