Neurophysiological assessment of the injured spinal cord: an intraoperative approach

Abstract

Study design: Prospective, observational study. Objectives: To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI). Setting: Regional Trauma Center, Torino, Italy. Methods: Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI-6 of them with central cord syndrome and 1 with central cord plus Brown Sequard syndrome-and 20 patients were neurologically uncompromised. Results: The neurophysiologic profile of the complete SCI was the absence of both m-MEPs and e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs cranially to the lesion site. None of these patients recovered motor function in the follow-up. A clearly detectable caudal D wave was associated with motor recovery even in deeply paraparetic patients. In one neurologically incomplete patient a reversible deterioration of m-MEPs and e-MEPs was observed during the compression-distraction manoeuvre. Conclusion: Intraoperative neurophysiological evaluation of SCI patients can provide information about spinal cord function that is not retrievable by other clinical means and can correctly predict neurological outcome. Intraoperative testing during early stabilization of the spine of deeply paraparetic SCI patients provides additional information about their neurological profile.

Traumatic spondyloptosis of L3 with incomplete neurological involvement: A case report

“…Currently, this tool plays a role in patients with severe paraparesis and forecasts future performance status. In the latter, it has been complemented with D-wave evaluation through an epidural catheter distal to the lesional site, even in the absence of motor evoked potentials (MEP) and indicates neurological recovery [10]. This was not possible in our case because the level of damage could not be determined in the D-wave recording.…”

Spinal cord bioelectronic interfaces: opportunities in neural recording and clinical challenges

“…This allows the surgeon to reverse any step that may injure the spinal cord and is especially useful during deformity correction [22] and intradural surgery [20] with its ability to increase the safety margin of spine surgery established [23]. SCR also serves to provide information on the level of injury in SCI and help to prognosticate the degree of motor recovery [139]. However, current modalities of direct SCR using D waves only capture information from the corticospinal tract fast-conducting fibres [140], leaving sectors of the spinal cord that could be monitored with more extensive mapping approaches [141] or more sophisticated timefrequency analysis of acquired signals [142].…”

Monitoreo neurofisiológico intraoperatorio en traumatismo raquimedular cervical y columna cervical compleja: Recomendaciones desde una visión dual basada en experiencia personal

“…Por otra parte, monitorizar estos casos, en especial aquellos con mielopatía de cualquier origen instaurada, también en un desafío, que comienza dede la posición quirúrgica en adelante, requiriendo técnicas de estimulación y registro diferentes, y en que la interpretación de ellas es crucial y determinante en maniobras quirúrgicas en tiempo real que definen pronóstico funcional. El MIO brinda beneficios en este respecto a pacientes indemnes, con déficit parcial, incluso a pacientes con profundo déficit neurológico preoperatorio 4 .…”