179. Intraoperative Multimodality Monitoring in Adult Spinal Deformity: Analysis of a Prospective Series of 102 Cases with Independent Evaluation

Quraishi, Nasir A.; Lewis, Stephen J.; Kelleher, Michael O.; Sarjeant, Roger; Rampersaud, Y. Raja; Fehlings, Michael G.

doi:10.1016/j.spinee.2008.06.216

Cited by 28 publications

(39 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Those of us who do not use cord monitoring have the view that one is committed to decompressing the spinal cord and that spinal cord monitoring is not going to change the surgical objective. Those who use it, have a strategy in place should there be a deterioration in the neurophysiological function and this is not too dissimilar to worsening of neuromonitoring in scoliosis patients [41,42]. For example, stopping the procedure in cases of significant drops in intra-operative monitoring, performing a wake-up test or even abandoning the anterior approach and performing a staged posterior decompression to allow the spinal cord to 'float dorsally' are strategies that we have employed in the past.…”

Section: Discussionmentioning

confidence: 99%

Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

View full text Add to dashboard Cite

Introduction Giant herniated thoracic discs (GHTD) remain a surgical challenge. When combined with calcification, these discs require altered surgical strategies and have only been infrequently described. Our objective was to describe our surgical approaches in the management of calcified GHTD. Methods This was a retrospective cohort study of all patients with calcified GHTD operated between 2004 and 2012. Data were collected from review of patients' notes and radiographs and included basic demographic and radiological data, clinical presentation and outcome, operative procedure and complications. Results During the study period, there were 13 patients with calcified GHTD, including 6 males and 7 females (mean age 55 years, range 31-83 years). The average canal encroachment was 62 % (range 40-90 %); mean follow-up 37 months (12-98). All patients were treated with anterior thoracotomy, varying degrees of vertebral resection, removal of calcified disc and with or without reconstruction. The average time for surgery was 344 min (range 212-601 min) and estimated blood loss 1,230 ml (range 350-3,000 ml). Post-operatively, 8 patients improved by 1 Frankel grade (62 %), 2 improved by 2 grades (15 %) and 3 did not change their grade (23 %). The complication rate was 4/13 (31 %; 3 patients with durotomies (2 incidental, 1 intentional) and 1 with recurrence). Discussion Calcified GHTD remain a surgical challenge. Anterior decompression through a thoracotomy approach, and varying degrees of vertebral resection with or without reconstruction allowed us to safely remove the calcified fragment. All patients remained the same (23 %) or improved by at least 1 grade (77 %) neurologically, without radiographic failure at final follow-up.

show abstract

Section: Discussionmentioning

confidence: 99%

Calcified giant thoracic disc herniations: considerations and treatment strategies

et al. 2014

View full text Add to dashboard Cite

show abstract

“…MEP monitoring is considered essential whenever spinal cord parenchyma is at risk. Thus, MEP monitoring is usually performed when the surgery includes the spinal cord and may be performed during spine surgery from C1 to sacrum since the location of the spinal cord varies by age and anatomic factors (e.g., tethered cord) [ 40,41 ] . At risk situations include any surgery where compromise of spinal cord perfusion or direct injury to motor tracks or nerve roots could occur.…”

Section: Application Of Mep Monitoringmentioning

confidence: 99%

Transcranial Motor Evoked Potentials

Jameson

2011

Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals

View full text Add to dashboard Cite

Motor-evoked potentials (MEPs) are the most recent addition to routine intraoperative neurophysiologic monitoring (IOM). Enthusiastic reports of improved outcomes obtained with the use of somatosenory evoked potential (SEP) monitoring, primarily for scoliosis procedures in children and young adults, were quickly followed by case reports of isolated postoperative motor injury without sensory changes [ 1 ] . These reports reflected the reality of the anatomy and physiology of motor/sensory pathways. MEP and SEP pathways are located in different topographic and vascular regions of the cerebral cortex, brainstem, and spinal cord. Motor functional pathways are more sensitive to ischemic insults than SEP pathways [ 2 ] .

show abstract

“…Quraishi et al reported the feasibility of IOM in surgery of adult spinal deformity. SSEP and MEP were measurable in 101 of 102 (99%) and 12 of 16 (75%), respectively [4]. Pelosi et al reported the feasibility of SSEP as 122/126 (97%) and that of MEP as 106/126 (84%) in patients with heterogeneous disease from spinal deformity to trauma.…”

Section: Feasibility Of Iom In Patients With Preoperative Neurologicamentioning

confidence: 99%

“…The intraoperative neurophysiologic monitoring (IOM), represented by motor evoked potential (MEP) and somatosensory evoked potential (SSEP), provides the functional integrity of spinal cord, and has become one of the essential procedures to avoid neural injury during spinal surgery [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Kang¹,

Gwak²,

Shin³

et al. 2016

J Spine

View full text Add to dashboard Cite

Objectives: To evaluate the feasibility, sensitivity and specificity of IOM for IDEM and ED metastatic spinal tumours, and to assess usefulness of SSEP for patients in whom MEP was not measurable. Methods and materials:One hundred and one consecutive patients with IDEM and ED metastatic spinal tumours at the cord level (C1 to L1) received surgery under SSEP and/or MEP was included. Feasibility of IOM was defined to be negative in case of no measurable MEP or SSEP under general anaesthesia after confirmation of reversal of neuromuscular block. More than 50% change of MEP or SSEP amplitude and more than 10% delay of SSEP latency were evaluated as positive signs of IOM change.Results: MEP was measurable in 74 out of 101 trials, thus feasibility is 73%. Patient with normal motor power showed higher feasibility than those with motor power 3 or less. (93% vs. 39%) Among 74 patients with measurable MEP, 19 patients showed positive MEP change and 14 patients got worse of their motor power postoperatively.

show abstract

179. Intraoperative Multimodality Monitoring in Adult Spinal Deformity: Analysis of a Prospective Series of 102 Cases with Independent Evaluation

Cited by 28 publications

References 0 publications

Calcified giant thoracic disc herniations: considerations and treatment strategies

Calcified giant thoracic disc herniations: considerations and treatment strategies

Transcranial Motor Evoked Potentials

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Contact Info

Product

Resources

About