Neuroprotection for Spine Surgery

2017 ◽  
Author(s):  
Jess W. Brallier ◽  
Jonathan S. Gal
Keyword(s):  
Evoked Potentials ◽  
Spine Surgery ◽  
Motor Evoked Potentials ◽  
Neurologic Injury ◽  
Arterial Blood ◽  
Increased Risk ◽  
Physiologic Parameter ◽  
The Common ◽  
Transcranial Motor Evoked Potentials

Perioperative neurologic injury related to spine surgery, albeit rare, can result in devastating functional loss. As the number of spine operations has increased, so has the need for strategies designed to avoid and protect against such injury. This chapter reviews the common etiologies of neurologic deficits secondary to spine surgery and the factors that place patients at increased risk for developing these complications. The use of intraoperative neuromonitoring, including somatosensory evoked potentials (SSEPs), electromyography (EMG), and transcranial motor evoked potentials (TcMEPs), to detect surgical trespass of neuronal elements is also reviewed. The authors also summarize the role of physiologic parameter optimization, including mean arterial blood pressure and body temperature, and pharmacologic interventions, should an injury occur. Current practice guidelines for preventing and managing perioperative neurologic injury are described.

Characteristics of Cases with Poor Transcranial Motor-evoked Potentials Baseline Waveform Derivation in Spine Surgery

Spine ◽  
2021 ◽  
Vol 46 (22) ◽  
pp. E1211-E1219
Author(s):  
Kazuyoshi Kobayashi ◽  
Shiro Imagama ◽  
Kei Ando ◽  
Go Yoshida ◽  
Muneharu Ando ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Spine Surgery ◽  
Motor Evoked Potentials ◽  
Transcranial Motor Evoked Potentials

The Cutoff Amplitude of Transcranial Motor-Evoked Potentials for Predicting Postoperative Motor Deficits in Thoracic Spine Surgery

Spine ◽  
2013 ◽  
Vol 38 (1) ◽  
pp. E21-E27 ◽  
Author(s):  
Akio Muramoto ◽  
Shiro Imagama ◽  
Zenya Ito ◽  
Norimitsu Wakao ◽  
Kei Ando ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Spine Surgery ◽  
Thoracic Spine ◽  
Motor Evoked Potentials ◽  
Motor Deficits ◽  
Transcranial Motor Evoked Potentials

scholarly journals Detection of acute femoral artery ischemia during neuroembolization by somatosensory and motor evoked potential monitoring

2015 ◽  
Vol 21 (3) ◽  
pp. 397-400 ◽  
Author(s):  
David Purger ◽  
Abdullah H Feroze ◽  
Omar Choudhri ◽  
Leslie Lee ◽  
Jaime Lopez ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Motor Evoked Potentials ◽  
Motor Evoked Potential ◽  
Postoperative Outcome ◽  
Limb Ischemia ◽  
Peripheral Ischemia ◽  
Increased Risk ◽  
Evoked Potential Monitoring ◽  
Transcranial Motor Evoked Potentials ◽  
The Right

Neuromonitoring can be used to map out particular neuroanatomical tracts, define physiologic deficits secondary to specific pathology or intervention, or predict postoperative outcome and proves essential in the detection of central and peripheral ischemic events during neurosurgical intervention. Herein, we describe an instance of elective balloon-assisted coiling of a recurrent basilar tip aneurysm in a 61-year-old woman, where intraoperative somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were lost in the right lower extremity intraoperatively. We aim to highlight that targeted use of monitoring proves advantageous in both the open surgical and endovascular setting, even in the avoidance of potential iatrogenic peripheral nerve damage and limb ischemia as documented herein. Consideration of the increased risk for peripheral ischemia in the neurointerventional setting is especially imperative in particular populations where blood vessels might be of diminished size, such as in infants, young children, and severely deconditioned adults.

scholarly journals Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist

2012 ◽  
Vol 33 (5) ◽  
pp. E10 ◽  
Author(s):  
Rishi R. Lall ◽  
Rohan R. Lall ◽  
Jason S. Hauptman ◽  
Carlos Munoz ◽  
George R. Cybulski ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Spine Surgery ◽  
Motor Evoked Potentials ◽  
Neurological Injury ◽  
Intraoperative Neurophysiological Monitoring ◽  
Neurophysiological Monitoring ◽  
Free Running ◽  
Evidence Based Guidelines ◽  
Medicolegal Issues

Spine surgery carries an inherent risk of damage to critical neural structures. Intraoperative neurophysiological monitoring (IONM) is frequently used to improve the safety of spine surgery by providing real-time assessment of neural structures at risk. Evidence-based guidelines for safe and efficacious use of IONM are lacking and its use is largely driven by surgeon preference and medicolegal issues. Due to this lack of standardization, the preoperative sign-in serves as a critical opportunity for 3-way discussion between the neurosurgeon, anesthesiologist, and neuromonitoring team regarding the necessity for and goals of IONM in the ensuing case. This analysis contains a review of commonly used IONM modalities including somatosensory evoked potentials, motor evoked potentials, spontaneous or free-running electromyography, triggered electromyography, and combined multimodal IONM. For each modality the methodology, interpretation, and reported sensitivity and specificity for neurological injury are addressed. This is followed by a discussion of important IONM-related issues to include in the preoperative checklist, including anesthetic protocol, warning criteria for possible neurological injury, and consideration of what steps to take in response to a positive alarm. The authors conclude with a cost-effectiveness analysis of IONM, and offer recommendations for IONM use during various forms of spine surgery, including both complex spine and minimally invasive procedures, as well as lower-risk spinal operations.

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