Intraoperative neurophysiological monitoring in selective dorsal rhizotomy (SDR)

Abstract

For decades, intraoperative neurophysiological monitoring (IONM) has been used to guide selective dorsal rhizotomy (SDR) for the treatment of spastic cerebral palsy (CP). Electromyography (EMG) interpretation methods, which are the core of IONM, have never been fully discussed and addressed, and their importance and necessity in SDR have been questioned for years. However, outcomes of CP patients who have undergone IONM-guided SDR have been favorable, and surgery-related complications are extremely minimal. In this paper, we review the history of evolving EMG interpretation methods as well as their neuroelectrophysiological basis.

Multimodal assessment of spasticity using a point-of-care instrumented glove to separate neural and biomechanical contributions

“…We made measurements on 21 patients before and after sedation and during the transition period from alertness to sedation under general anesthesia. As anesthesia suppressed neural reflex excitation ( Fee and Miller, 2004 ; Jiang et al., 2020 ), this study facilitated self-consistent comparisons to separate the neural and structural contributions to spasticity, which until now these contributions have been very challenging to differentiate but are very important for identifying the underlying origins of spasticity and symptom management ( Fee and Miller, 2004 ; Smith et al., 2011 ; Sinkjær and Magnussen, 1994 ). For example, it has been suggested that spasticity in patients with predominantly hyperactive reflexes was likely to respond well to functional electrical stimulation, whereas other patients responded less well to the same stimulation therapy ( Alhusaini, 2013 ).…”