The Use of Dermatomal Evoked Responses During Surgical Procedures That Use Intrapedicular Fixation of the Lumbosacral Spine

Toleikis, J. Richard; Carlvin, Arnold O.; Shapiro, David E.; Schäfer, Michael F.

doi:10.1097/00007632-199312000-00006

Cited by 58 publications

(21 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…All the studies including [2,4,6,12,13]. In our institution, we introduced a multimodal intraoperative monitoring with sensory and motor-evoked potentials and particularly selective nerve root monitoring for each miotom in a side-by-side comparison.…”

Section: Discussionmentioning

confidence: 99%

“…Among these techniques, continuous EMG recording, somatosensoryevoked potentials and compound muscle action potentials by electrical stimulation of the motor cortex or the spinal cord are the most frequently used [2,4,6,12,13]. Bose et al [2] concluded that continuous intraoperative electromyographic monitoring provided a real-time measurement of impending spinal nerve root injury during instrumented posteriolumbar fusion, allowing for timely intervention and minimizing the risk of nerve root damage.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

et al. 2007

View full text Add to dashboard Cite

A prospective study on 409 patients who received multimodel intraoperative monitoring (MIOM) during lumbosacral surgical procedures between March 2000 and December 2005 was carried out. The objective of this study was to determine the sensitivity and specificity of MIOM techniques used to monitor conus medullaris, cauda equina and nerve root function during lumbosacral decompression surgery. MIOM has increasingly become important to monitor ascending and descending pathways, giving immediate feedback information regarding any neurological deficit during the decompression and stabilisation procedure in the lumbosacral region. Intraoperative spinal-and cortical-evoked potentials, combined with continuous EMG-and motor-evoked potentials of the muscles, were evaluated and compared with postoperative clinical neurological changes. A total of 409 consecutive patients with lumbosacral spinal stenosis with or without instability were monitored by MIOM during the entire surgical procedure. A total of 388 patients presented truenegative findings while two patients presented false negative and 1 patient false-positive findings. Eighteen patients presented true-positive findings where neurological deficit after the operation was intraoperatively predicted. Of the 18 true-positive findings, 12 patients recovered completely; however, 6 patients recovered only partially. The sensitivity of MIOM applied during decompression and fusion surgery of the lumbosacral region was calculated as 90%, and the specificity was calculated as 99.7%. On the basis of the results of this study, MIOM is an effective method of monitoring the conus medullaris, cauda equina and nerve root function during surgery at the lumbosacral junctions and might reduce postoperative surgical-related complications and therefore improve the long-term results.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

et al. 2007

View full text Add to dashboard Cite

show abstract

“…A case has been documented in which the intrapedicular ®xation procedure that was monitored with SEPs resulted in false-negative SEPs ®ndings. 44 These data suggest that SEPs may not be a su ciently sensitive monitoring tool for detecting an abnormality of a single root function, and as a result, other monitoring techniques should be used.…”

Section: Monitoring Root Functionmentioning

confidence: 98%

“…In addition, in a prospective study of 81 lumbosacral intrapedicular procedures, it was found that predictions of post-operative outcome were dependent only on the response on completion of surgery and not on changes that occurred during surgery. 44 The recording of electromyographic activity from the muscle controlled by the root to be tested is an alternative to DSEPs. The EMG activity can be elicited by a mechanical irritation or by an electrical stimulation.…”

Section: Monitoring Root Functionmentioning

confidence: 99%

Intra-operative spinal cord monitoring in orthopaedics

Macri¹,

Monte²,

Greggi³

et al. 2000

Spinal Cord

View full text Add to dashboard Cite

The surgical correction of spinal deformities carries a small but signi®cant risk of injury to the spinal cord. To detect the onset and possibly reverse the e ects of surgical complication, a variety of neurophysiological monitoring procedures can be employed. The purpose of this review is to provide information regarding the various methodologies available for monitoring spinal cord and nerve root function during orthopaedic procedures. Intra-operative monitoring of cortically recorded somatosensory evoked potentials (SEPs) by peripheral nerve stimulation is of value during orthopaedic surgery and is the state-of-the-art in terms of non-invasiveness, versatility, time requirement, lateral discrimination, and ease of electrode placement. Monitoring of motor evoked potentials (MEPs) is useful particularly in combination with SEPs but is still considered investigational. Root function monitoring has limited application and requires more clinical research. Spinal Cord (2000) 38, 133 ± 139

show abstract

“…Cortical somatosensory evoked potential (CSEP), elicited by peripheral-nerve o r dermatomal stimulation, is unable to provide immediate information when a single root is injured [25]. Evoked or spontaneous electromyography (EMG)-valuable for determining the appropriate placement of pedicle screws [1-3,12,15,21]-is easily affected by muscle relaxants and loses its reliability once the pedicle wall is broken.…”

Section: Introductionmentioning

confidence: 99%

Spinal somatosensory evoked potential evaluation of acute nerve‐root injury associated with pedicle‐screw placement procedures: An experimental study

Jou

Hsu

Chern

et al. 2003

Journal Orthopaedic Research

View full text Add to dashboard Cite

Pedicle screws for spinal fixation risk neural damage because of the proximity between screw and nerve root. We assessed whether spinal somatosensory evoked potential (SSEP) could selectively detect pedicle-screw-related acute isolated nerve injury. Because pedicle screws are too large for a rat's spine, we inserted a K-wire close to the pedicle in 32 rats, intending not to injure the nerve root in eight (controls), and to injure the L4 or L5 root in 24. We used sciatic-nerve-elicited SSEP pre-and postinsertion. Radiologic, histologic, and postmortem observations confirmed the level and degree of root injury. Sciatic (SFI), tibia1 (TFI), and peroneal function indices (PFI) were calculated and correlated with changes in potential. Although not specific for injuries to different roots, amplitude reduction immediately postinsertion was significant in the experimental groups. Animals with the offending wire left in place for one hour showed a further non-significant deterioration of amplitude. Electrophysiologic changes correlated with SF1 and histologic findings in all groups. SSEP monitoring provided reliable, useful diagnostic and intraoperative information about the functional integrity of single nerve-root injury. These findings are clinically relevant to acute nerve-root injury and pedicle-screw insertion. If a nerve-root irritant remains in place, a considerable neurologic deficit will occur.

show abstract

The Use of Dermatomal Evoked Responses During Surgical Procedures That Use Intrapedicular Fixation of the Lumbosacral Spine

Cited by 58 publications

References 0 publications

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

Multimodal intraoperative monitoring (MIOM) during 409 lumbosacral surgical procedures in 409 patients

Intra-operative spinal cord monitoring in orthopaedics

Spinal somatosensory evoked potential evaluation of acute nerve‐root injury associated with pedicle‐screw placement procedures: An experimental study

Contact Info

Product

Resources

About