Distal Stimulation Site at the Medial Tibia for Saphenous Nerve Somatosensory Evoked Potentials (DSn-SSEPs) in Lateral Lumbar Spine Procedures

Overzet, Kathryn; Mora, Derrick; Faust, E.L.; Krisko, Lindsay; Welch, Dyanne; Jahangiri, Faisal R

doi:10.1080/21646821.2021.1903277

Cited by 2 publications

(14 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The average SN-SSEP amplitude of 0.71 uV falls significantly above the statistically observed cutoff for monitorability of 0.27 uV and the previously reported average of 0.48 uV. 3 The neurophysiological techniques mentioned, including the use of train stimulation, are likely factors in the high rates of monitorability and improved response quality observed. Further investigation is required to confirm and optimize stimulation parameters for SN-SSEP monitoring.…”

Section: Discussionmentioning

confidence: 60%

“…Stimulating distal to the knee rather than at the medial thigh likely facilitated monitoring in patients with higher BMI and/or larger body habitus. 2,3,12 In the subgroup of obese patients analyzed, SN-SSEPs were found to require greater stimulation intensities and have lower response amplitudes as compared with TN-SSEPs. Yet, the overall monitorability of SN-SSEPs was not significantly affected by obesity.…”

Section: Discussionmentioning

confidence: 98%

“…Previous studies have shown SN-SSEP monitoring to be effective in predicting femoral nerve deficits 1,2 ; however, investigators continue to describe SN-SSEPs as technically challenging to acquire and call for the use of total intravenous anesthesia due to low response amplitudes and unobtainable responses in as high as 16% of patients. 2,3 This study includes the largest data set to date of N = 563 patients undergoing lumbar spine surgery with continuous SN-SSEP monitoring without controlling for anesthesia. In the assessment of overall monitorability and neurophysiology techniques used, results show SN-SSEPs to have a high rate of monitorability (92.3%) with the use of an anesthetic inhalant in 97.7% of procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Spine 2024;49:923-932 S aphenous nerve somatosensory evoked potentials (SN-SSEPs) have been proposed for detecting lumbar plexus and femoral nerve injury during lateral transpsoas approaches to lumbar spine surgery where traditional intraoperative neuromonitoring (IONM) protocols prove insufficient. [1][2][3] Lateral lumbar interbody fusion is a minimally invasive retroperitoneal, transpsoas procedure that allows for the avoidance of vascular and soft tissue complications associated with anterior and posterior approaches to lumbar spine surgery while demonstrating maintained improvements in patient outcomes and higher fusions rates. [4][5][6] Despite these benefits, lateral lumbar interbody fusion approaches have been shown to have increased risk to the lumbar plexus resulting in high incidence of injury, with motor weaknesses reported in up to 34% of patients and sensory deficits reported in up to 75% of patients postoperatively.…”

mentioning

confidence: 99%

“…As the largest cutaneous branch of the femoral nerve (L2-4), the saphenous nerve derives from L3-L4 roots and innervates the skin of the medial thigh to the ankle. 3,17,18 When stimulated below the knee, SN-SSEPs derive solely from the L4 nerve root and provide a means of single-nerve root monitoring. This unique SSEP fills the need for more specified lumbar neuromonitoring applicable to all types of lumbar surgery.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Feasibility of Saphenous Nerve Somatosensory-Evoked Potential Intraoperative Monitoring During Lumbar Spine Surgery

Rucker,

Singh,

Mai

et al. 2024

Spine

View full text Add to dashboard Cite

Study Design. Retrospective review. Objective. Assess the feasibility of saphenous nerve somatosensory evoked potentials (SN-SSEP) monitoring in lumbar spine surgeries. Background Context. SN-SSEPs have been proposed for detecting lumbar plexus and femoral nerve injury during lateral lumbar surgery where tibial nerve (TN)SSEPs alone are insufficient. SN-SSEPs may also be useful in other types of lumbar surgery, as stimulation of SN below the knee derives solely from the L4 root and provides a means of L4 monitoring, whereas TN-SSEPs often do not detect single nerve root injury. The feasibility of routine SN-SSEP monitoring has not been established. Methods. A total of 563 consecutive cases using both TN and SN-SSEP monitoring were included. Anesthesia was at the discretion of the anesthesiologist, using an inhalant in 97.7% of procedures. SN stimulation was performed using 13 mm needle electrodes placed below the knee using 200-400 μsec pulses at 15-100 mA. Adjustments to stimulation parameters were made by the neurophysiology technician while obtaining baselines. Data were graded retrospectively for monitorability and cortical response amplitudes were measured by two independent reviewers. Results. 98% of TN-SSEPs and 92.5% of SN-SSEPs were monitorable at baseline, with a mean response amplitude of 1.35 μV for TN-SSEPs and 0.71 μV for SN-SSEPs. A significant difference between the stimulation parameters used to obtain reproducible TN and SN-SSEPs at baseline was observed, with SN-SSEPs requiring greater stimulation intensities. Body mass index (BMI) is not associated with baseline monitorability. Out of 20 signal changes observed, 11 involved SN while TN-SSEPs were unaffected. Conclusion. With adjustments to stimulation parameters, SN-SSEP monitoring is feasible within a large clinical cohort without modifications to the anesthetic plan. Incorporating SN into standard intraoperative neurophysiological monitoring (IONM) protocols for lumbar spine procedures may expand the role of SSEP monitoring to include detecting injury to the lumbar plexus. Level of Evidence. 3

show abstract

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Feasibility of Saphenous Nerve Somatosensory-Evoked Potential Intraoperative Monitoring During Lumbar Spine Surgery

Rucker,

Singh,

Mai

et al. 2024

Spine

View full text Add to dashboard Cite

show abstract

Intraoperative somatosensory evoked potential (SEP) monitoring: an updated position statement by the American Society of Neurophysiological Monitoring

Toleikis,

Pace,

Jahangiri

et al. 2024

J Clin Monit Comput

View full text Add to dashboard Cite

Somatosensory evoked potentials (SEPs) are used to assess the functional status of somatosensory pathways during surgical procedures and can help protect patients’ neurological integrity intraoperatively. This is a position statement on intraoperative SEP monitoring from the American Society of Neurophysiological Monitoring (ASNM) and updates prior ASNM position statements on SEPs from the years 2005 and 2010. This position statement is endorsed by ASNM and serves as an educational service to the neurophysiological community on the recommended use of SEPs as a neurophysiological monitoring tool. It presents the rationale for SEP utilization and its clinical applications. It also covers the relevant anatomy, technical methodology for setup and signal acquisition, signal interpretation, anesthesia and physiological considerations, and documentation and credentialing requirements to optimize SEP monitoring to aid in protecting the nervous system during surgery.

show abstract

Distal Stimulation Site at the Medial Tibia for Saphenous Nerve Somatosensory Evoked Potentials (DSn-SSEPs) in Lateral Lumbar Spine Procedures

Cited by 2 publications

References 12 publications

Feasibility of Saphenous Nerve Somatosensory-Evoked Potential Intraoperative Monitoring During Lumbar Spine Surgery

Feasibility of Saphenous Nerve Somatosensory-Evoked Potential Intraoperative Monitoring During Lumbar Spine Surgery

Intraoperative somatosensory evoked potential (SEP) monitoring: an updated position statement by the American Society of Neurophysiological Monitoring

Contact Info

Product

Resources

About