Somatosensory evoked potential monitoring detection of carotid compression during ACDF surgery in a patient with a vascularly isolated hemisphere

Legatt, Alan D.; Laarakker, Avra S.; Nakhla, Jonathan; Nasser, Rani; Altschul, David

doi:10.3171/2016.4.spine151481

Cited by 9 publications

(5 citation statements)

References 12 publications

(12 reference statements)

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“…MEPs are also highly sensitive (100%)14 whereas SSEPs are much less so (17.7%–35.2%) 14,23. Case reports describe unique situations, in which IONM detected arterial compression and brachial plexopathy due to shoulder traction 25,26…”

Section: Discussionmentioning

confidence: 99%

“…14,23 Case reports describe unique situations, in which IONM detected arterial compression and brachial plexopathy due to shoulder traction. 25,26 Several database studies have been performed similarly to our investigation. Cole and colleagues performed a retrospective analysis using the MarketScan national database of single-level spinal procedures including ACDF, lumbar laminectomy, lumbar discectomy, and lumbar fusion between 2006 and 2010.…”

Section: Intraoperative Neuromonitoring Utilizationmentioning

confidence: 99%

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Utilization Trends of Intraoperative Neuromonitoring for Anterior Cervical Discectomy and Fusion in New York State

Zelenty

Paek

Dodo

et al. 2022

Spine

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Study Design. Retrospective cohort analysis. Objective. To elucidate trends in the utilization of intraoperative neuromonitoring (IONM) during anterior cervical discectomy and fusion (ACDF) procedures in NY state using the Statewide Planning and Research Cooperative System and to determine if utilization of IONM resulted in a reduction in postoperative neurological deficits. Summary of Background Data. IONM has been available to spinal surgeons for several decades. It has become increasingly prevalent in all facets of spinal surgery including elective ACDF procedures. The utility of IONM for preventing a neurological deficit in elective spine procedures has recently been called into question. Materials and Methods. The Statewide Planning and Research Cooperative System database were accessed to perform a retrospective cohort study comparing monitored versus unmonitored ACDF procedures between 2007 and 2018 as defined by the International Classification of Disease-9 and 10 Procedural Coding System (ICD-9 PCS, ICD-10 PCS) codes. Patient demographics, medical history, surgical intervention, pertinent in-hospital events, and urban versus rural medical centers (as defined by the United States Office of Management and Budget) were recorded. Propensity-score-matched comparisons were used to identify factors related to the utilization of IONM and risk factors for neurological deficits after elective ACDF. Results. A total of 70,838 [15,092 monitored (21.3%) and 55,746 (78.7%) unmonitored] patients’ data were extracted. The utilization of IONM since 2007 has increased in a linear manner from 0.9% of cases in 2007 to 36.7% by 2018. Overall, baseline characteristics of patients who were monitored during cases differed significantly from unmonitored patients in age, race/ethnicity, insurance type, presence of myelopathy or radiculopathy, and Charlson Comorbidity Index; however, only race/ethnicity was statistically significant when analyzed using propensity-score-matched. When comparing urban and rural medical centers, there is a significant lag in the adoption of the technology with no monitored cases in rural centers until 2012 with significant fluctuations in utilization compared with steadily increasing utilization among urban centers. From 2017 to 2018, reporting of neurological deficits after surgery resembled literature-established norms. Pooled analysis of these years revealed that the incidence of neurological complications occurred more frequently in monitored cases than in unmonitored (3.0% vs. 1.4%, P < 0.001). Conclusions. The utility of IONM for elective ACDF remains uncertain; however, it continues to gain popularity for routine cases. For medical centers that lack similar resources to centers in more densely populated regions of NY state, reliable access to this technology is not a certainty. In our analysis of intraoperative neurological complications, it seems that IONM is not protective against neurological injury.

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Section: Discussionmentioning

confidence: 99%

Section: Intraoperative Neuromonitoring Utilizationmentioning

confidence: 99%

Utilization Trends of Intraoperative Neuromonitoring for Anterior Cervical Discectomy and Fusion in New York State

Zelenty

Paek

Dodo

et al. 2022

Spine

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“…Cervical traction (5-15 lbs) may be appropriate, especially in cases of intervertebral disk degeneration. Intraoperative monitoring, including somatosensory and transcranial motor evoked potentials, is recommended as it may help to prevent iatrogenic injury to the spinal cord or roots (Davis et al 2013;Legatt et al 2016).…”

Section: Surgery Positioning and Monitoringmentioning

confidence: 99%

Anterior Spinal Plates, Cervical

Ahmed¹,

Pennington²,

Molina³

et al. 2020

Handbook of Spine Technology

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Anterior cervical diskectomy and fusion (ACDF) is one of the most common and effective spine procedures performed, indicated for the treatment of cervical degenerative disk disease. Patients frequently present with neck pain, radiculopathy, or myelopathy secondary to compression of the neural elements. A thorough patient evaluation is performed, consisting of clinical examination, imaging, and possibly nerve conduction studies. This chapter outlines the diagnostic evaluation, indications, operative details, considerations, and complications of the ACDF procedure.

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“…Legatt et al 22 reported a case of anterior cervical discectomy and fusion surgery in which findings on somatosensoryevoked potential monitoring led to the correction of carotid artery compression in a patient with a vascularly isolated hemisphere (no significant collateral blood vessels to the carotid artery territory), and the patient suffered no neurological morbidity. During anterior cervical spine surgery, carotid artery compression by the surgical retractor can cause hemispheric ischemia and infarction in patients with inadequate collateral circulation.…”

Section: Anterior Fusionmentioning

confidence: 99%

Intraoperative Neurophysiological Monitoring for Spinal Fusion

Vasques¹,

Fonseca²

2017

Arq Bras Neurocir

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The surgical techniques of spinal fusion are frequently used in the treatment of many spine conditions. Apart from having anatomical knowledge, in order to perform those procedures safely, it is essential to utilize all the tools available to assure the appropriate positioning of the materials and avoid neural injury. The goal of this article is to review the literature on the use of intraoperative neurophysiological monitoring for spinal fusion procedures and to discuss the controversies regarding this issue.

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Somatosensory evoked potential monitoring detection of carotid compression during ACDF surgery in a patient with a vascularly isolated hemisphere

Cited by 9 publications

References 12 publications

Utilization Trends of Intraoperative Neuromonitoring for Anterior Cervical Discectomy and Fusion in New York State

Utilization Trends of Intraoperative Neuromonitoring for Anterior Cervical Discectomy and Fusion in New York State

Anterior Spinal Plates, Cervical

Intraoperative Neurophysiological Monitoring for Spinal Fusion

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