Electromyography detects mechanically-induced suprasegmental spinal motor tract injury: Review of decompression at spinal cord level

Skinner, Stanley A.; Transfeldt, Ensor E.; Mehbod, Amir A.; Mullan, John C.; Perra, Joseph H.

doi:10.1016/j.clinph.2008.11.030

Cited by 37 publications

(14 citation statements)

References 45 publications

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“…Pigs are well established as pediatric and adult models of traumatic brain injury, 28 chronic spinal cord pathology, 12,21,78 and ischemic SCI. 66 Traumatic SCI pig models have used weightdrop, 9 pneumatic impactor, 52 and clip compression 79,92 techniques. In our opinion, pigs are a suitable SCI model because their CNS is similar to that of humans in several respects, including blood supply and flow characteristics, 30,80 white and gray matter distribution, brain and spinal cord growth and development, 22 and spinal skeletal similarities.…”

Section: Injury Modelmentioning

confidence: 99%

“…64,66,75,85 There are several reports of contusion 9,52 and clip compression 79,92 SCI models in pigs, although most do not provide a biomechanical analysis of the impact (impactor shape, energy, velocity, force). The pig has spinal cord 8,79 and CSF dimensions that are similar to those of an adult human 33,44,48,91 and is therefore suitable to characterize various aspects of the biomechanics of SCI, and in particular of the role of CSF during and immediately after the injury.…”

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confidence: 99%

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Development of a large-animal model to measure dynamic cerebrospinal fluid pressure during spinal cord injury

Jones

Lee

Cripton

2012

SPI

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Object Spinal cord injury (SCI) often results in considerable permanent neurological impairment, and unfortunately, the successful translation of effective treatments from laboratory models to human patients is lacking. This may be partially attributed to differences in anatomy, physiology, and scale between humans and rodent models. One potentially important difference between the rodent and human spinal cord is the presence of a significant CSF volume within the intrathecal space around the human cord. While the CSF may “cushion” the spinal cord, pressure waves within the CSF at the time of injury may contribute to the extent and severity of the primary injury. The objective of this study was to develop a model of contusion SCI in a miniature pig and establish the feasibility of measuring spinal CSF pressure during injury. Methods A custom weight-drop device was used to apply thoracic contusion SCI to 17 Yucatan miniature pigs. Impact load and velocity were measured. Using fiber optic pressure transducers implanted in the thecal sac, CSF pressures resulting from 2 injury severities (caused by 50-g and 100-g weights released from a 50-cm height) were measured. Results The median peak impact loads were 54 N and 132 N for the 50-g and 100-g injuries, respectively. At a nominal 100 mm from the injury epicenter, the authors observed a small negative pressure peak (median −4.6 mm Hg [cranial] and −5.8 mm Hg [caudal] for 50 g; −27.6 mm Hg [cranial] and −27.2 mm Hg [caudal] for 100 g) followed by a larger positive pressure peak (median 110.5 mm Hg [cranial] and 77.1 mm Hg [caudal] for 50 g; 88.4 mm Hg [cranial] and 67.2 mm Hg [caudal] for 100 g) relative to the preinjury pressure. There were no significant differences in peak pressure between the 2 injury severities or the caudal and cranial transducer locations. Conclusions A new model of contusion SCI was developed to measure spinal CSF pressures during the SCI event. The results suggest that the Yucatan miniature pig is an appropriate model for studying CSF, spinal cord, and dura interactions during injury. With further development and characterization it may be an appropriate in vivo largeanimal model of SCI to answer questions regarding pathological changes, therapeutic safety, or treatment efficacy, particularly where humanlike dimensions and physiology are important.

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Section: Injury Modelmentioning

confidence: 99%

mentioning

confidence: 99%

Development of a large-animal model to measure dynamic cerebrospinal fluid pressure during spinal cord injury

Jones

Lee

Cripton

2012

SPI

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“…8 We lost motor evoked potential (MEP) in 15 patients: 4/5 with unrecovered MEP had postoperative SCI; 10/10 patients with recovered MEP through specific interventions had no deficit. The understudied problem of false-positive MEP monitoring must be considered.…”

Section: Author Response: Ronald G Emerson New Yorkmentioning

confidence: 99%

Evidence-based guideline update: Intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Clinical Neurophysiology Society

Minahan¹,

Legatt²,

Galloway³

et al. 2012

Neurology

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van der Goes, Seattle: Nuwer et al.1 consolidated the best evidence available on the use of evoked potentials during spinal operations. However, focusing on the value of intraoperative neurophysiological monitoring (IOM) alerts in predicting postoperative motor deficits does not offer new answers to the question "Why use IOM?" The guideline authors agree with the results of a review 2 that supported IOM as a predictive diagnostic tool with a high level of evidence. Prediction alone is insufficient to warrant use of IOM especially when actual outcomes will be revealed almost immediately following the surgery. Also, short-term prediction is insufficient to justify the costs of the specialized equipment, technicians, and professional oversight necessary for proper IOM performance. The evidence for IOM to alter outcomes is weak with only one nonrandomized study 3 showing a 52% rate of preventing neurologic deficits from acting on IOM alerts. In the absence of randomized controlled trials, outcomes research from large observational datasets may clarify the utility of IOM as cost-effectiveness becomes a greater factor in medical decision-making.

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“…Both mechanical distortion and ischemia can produce time-dependent structural damage. However, if the pathophysiology is relieved quickly enough by undoing the offending surgical maneuver, then the affected neural elements and their EPs can recover (Macdonald et al, 2007;Skinner et al, 2009). …”

Section: Qualification: Associations Between Surgical Events Eps Anmentioning

confidence: 99%

Somatosensory and motor evoked potentials as biomarkers for post-operative neurological status

Holdefer¹,

MacDonald²,

Skinner³

2015

Clinical Neurophysiology

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Electromyography detects mechanically-induced suprasegmental spinal motor tract injury: Review of decompression at spinal cord level

Cited by 37 publications

References 45 publications

Development of a large-animal model to measure dynamic cerebrospinal fluid pressure during spinal cord injury

Development of a large-animal model to measure dynamic cerebrospinal fluid pressure during spinal cord injury

Evidence-based guideline update: Intraoperative spinal monitoring with somatosensory and transcranial electrical motor evoked potentials: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and the American Clinical Neurophysiology Society

Somatosensory and motor evoked potentials as biomarkers for post-operative neurological status

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