The Use of Intraoperative Electromyogram During Spinal Cord Stimulator Placement Surgery: A Case Series

Schoen, Nathan; Chieng, Lee Onn; Madhavan, Karthik; Jermakowicz, Walter J.; Vanni, Steven

doi:10.1016/j.wneu.2016.12.077

Cited by 13 publications

(6 citation statements)

References 11 publications

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“…Falowski et al performed a retrospective analysis of 329 permanent paddle implantations and noted a 14.9% failure rate as compared to a 29.7% failure rate from awake implantation over a five year follow‐up period . Likewise, Schoen et al in 2017 performed a review on 103 patients who underwent paddle placement using IONM with a reported complication and revision rate of 13.6%, the authors did not include their mean follow‐up period but they included patients over a six year period ending one year prior to publication, their mean time to failure was 14.6 months . Our data show a comparable rate of failure to patients undergoing an awake implantation of a SCS system and our revision/removal rate was 21.3% over long‐term follow‐up data.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, IONM serves as an electrophysiological correlate rather than a subjective one after lead placement. IONM provides improved patient comfort and multiple studies show a lower revisions rate and at least equivocal pain outcomes . Specifically, IONM can be used to confirm laterality, using either somatosensory evoked potentials collision data or using evoked electromyography (EMG) responses .…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative Neuromonitoring in Percutaneous Spinal Cord Stimulator Placement

Hwang

Field

Kumar

et al. 2019

Neuromodulation: Technology at the Neural Interface

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative Neuromonitoring in Percutaneous Spinal Cord Stimulator Placement

Hwang

Field

Kumar

et al. 2019

Neuromodulation: Technology at the Neural Interface

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“…Epidural electrical stimulation (EES) of the spinal cord is broadly known as a treatment for chronic intractable pain of the trunk and limbs (Krames et al, 2009;Rock et al, 2019;Shealy et al, 1967). For this indication, EES is generally applied at C2-C3 vertebral levels for neck and upper-extremity pain (Rock et al, 2019;Schoen et al, 2017) and at T8-T10 for lower-back and lower-extremity coverage (Air et al, 2012;Shils and Arle, 2018) and is associated with the stimulation of ascending fiber branches of cutaneous afferents in the spinal cord dorsal columns (Holsheimer, 1998;Shils and Arle, 2012;Tulgar et al, 1993). Its use in motor disorders has a history nearly as long as in pain (Cook and Weinstein, 1973;Illis et al, 1976;Minassian et al, 2012), with neuromodulation of spasticity having been the initial interest in spinal cord injury (SCI) (Barolat et al, 1995;Dimitrijevic et al, 1986;Richardson et al, 1979).…”

Section: Introductionmentioning

confidence: 99%

Spinal motor mapping by epidural stimulation of lumbosacral posterior roots in humans

et al. 2021

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Epidural electrical stimulation of the spinal cord is an emergent strategy for the neurological recovery of lower-extremity motor function. Motoneuron pools are thought to be recruited by stimulation of posterior roots. Here, we linked electromyographic data of epidurally evoked lower-extremity responses of 34 individuals with upper motoneuron disorders to a population model of the spinal cord constructed using anatomical parameters of thousands of individuals. We identified a relationship between segmental stimulation sites and activated spinal cord segments, which made spinal motor mapping from epidural space possible despite the complex anatomical interface imposed by the posterior roots. Our statistical approach provided evidence for low-threshold sites of posterior roots and effects of monopolar and bipolar stimulation previously predicted by computer modeling and allowed us to test the impact of different upper motoneuron disorders on the evoked responses. Finally, we revealed a statistical association between intraoperative and postoperative mapping of the spinal cord.

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“…For patients with a deviation of the spinal cord from the midline of the canal, a more desirable method of verification would be neurophysiological monitoring. This includes electromyography and somatosensory-evoked potential collision studies (SSEP-CS), which have recently been used in patients with chronic pain [16][17][18]. Electromyography is more sensitive and helps guide device programming [16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Proposal of a Novel Procedure for C2-4 Cervical Spinal Cord Stimulator Implantation to Improve Complete Midline Coverage via Electrode Array in Patients with Disorders of Consciousness: A Retrospective Single-Center Study

Dang¹,

Xia²,

Yang³

et al. 2023

J. Integr. Neurosci.

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Background: Deviation of electrode array from the midline of spinal cords affects the therapeutic outcomes of C2-4 cervical spinal cord stimulation (SCS) in patients with disorders of consciousness (DOC). This study proposed the implementation of a novel C2-3 dural exposure procedure and investigated its efficacy compared to conventional surgery. Methods: Surgical and postoperative imaging data from 69 patients with DOC who underwent SCS in the lateral decubitus position were retrospectively assessed. The C2-3 dural exposure procedure was performed in 16 patients while the rest underwent conventional surgery. The incidence of electrode deviation was compared, and factors associated with the deviation were investigated. Results: The rate of complete midline coverage by the electrodes in the C2-3 dural exposure group was significantly higher than the conventional group (93.8% vs. 54.7%, p = 0.004). Exposure of the dura between C2-3 was a significant favorable factor for complete midline coverage by the electrode array (odds ratio [OR]: 0.091; 95% confidence interval [CI]: 0.011-0.757; p = 0.027). Electrode positioned ≥5 cm above the lower edge of the C2 vertebra was a significant risk factor for incomplete midline coverage (OR: 1.126; 95% CI: 1.016-1.248; p = 0.023). No difference in operation time, intraoperative bleeding, or surgical site infection was observed between the 2 groups. Conclusions: The C2-3 dural exposure procedure, performed in the lateral decubitus position, was safe and had higher complete midline coverage than conventional surgery.

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The Use of Intraoperative Electromyogram During Spinal Cord Stimulator Placement Surgery: A Case Series

Cited by 13 publications

References 11 publications

Intraoperative Neuromonitoring in Percutaneous Spinal Cord Stimulator Placement

Intraoperative Neuromonitoring in Percutaneous Spinal Cord Stimulator Placement

Spinal motor mapping by epidural stimulation of lumbosacral posterior roots in humans

Proposal of a Novel Procedure for C2-4 Cervical Spinal Cord Stimulator Implantation to Improve Complete Midline Coverage via Electrode Array in Patients with Disorders of Consciousness: A Retrospective Single-Center Study

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