Effect of Electromyography Findings of Traction-Related Signal Loss on Prognosis During Neuromonitored Thyroidectomy.

Karaisli, Serkan; Gucek Haciyanli, Selda; Gur, Emine Ozlem; Haciyanli, Mehmet · Head Neck · 2026

case_series · Level IV

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Abstract

Intraoperative neuromonitoring (IONM) is a reliable tool to detect electromyographic loss of signal (LOS). Here, we investigated the effect of electromyography features of traction-related LOS on prognosis. Thyroidectomy patients with a traction-related LOS were included. The cases were divided into four groups as follows: Type 1 LOS with no amplitude (0 μV) (Group 1), Type 1 LOS with low-amplitude (1-99 μV) (Group 2), Type 2 LOS with no amplitude (Group 3), and Type 2 LOS with low-amplitude (Group 4). A total of 788 patients (1429 nerves) were analyzed. Traction-related LOS was found in 74 patients (9.4%) and 77 nerves (5.4%). Intraoperative recovery was observed in 21 (48.8%) nerves in Group 4, and significantly higher (p = 0.011). Vocal cord paralysis was less in Group 4 (p = 0.001). In traction-related injury, electromyography features may contribute to the decision-making process. Type 2 LOS with low-amplitude is associated with a high likelihood of intraoperative recovery, potentially reducing the need for staged thyroidectomy.