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Faisal R Jahangiri, Sami Al Eissa, Samir Sayegh, Fahad Al Helal, Shomoukh A Al-Sharif, Monerah M Annaim, Sheryar Muhammad, Tanweer Aziz
A 16-year-old male patient with Ehler-Danlos syndrome (EDS) and a back deformity since birth presented with severe kyphoscoliosis. The patient was neurologically intact but had respiratory and cardiac insufficiencies. A two-stage vertebral column resection (VCR) at T9-T10 with multiple level fusion with multimodality intraoperative neurophysiological monitoring (IONM) was planned.  During the first stage, pedicle screws were placed at multiple spinal levels above and below the VCR level. Upper and lower somatosensory evoked potentials (SSEP), transcranial electrical motor evoked potentials (TCeMEP), and electromyography were monitored continuously and showed no significant changes...
August 31, 2016: Curēus
Siavash S Haghighi, Donald J Blaskiewicz, Bertha Ramirez, Richard Zhang
BACKGROUND: C5 nerve root palsy is a known complication after cervical laminectomy or laminoplasty, characterized by weakness of the deltoid and bicep brachii muscles. The efficacy of intraoperative monitoring of these muscles is currently unclear. In the current prospective study, intraoperative monitoring through somatosensory (SSEPs), motor (TcMEPs) evoked potentials and real-time electromyography activity (EMG) were analyzed for their ability to detect or prevent deltoid muscle weakness after surgery...
September 2016: J Spine Surg
Qing Yue, Tyson Hale, Aaron Knecht, Jennifer Laidacker
BACKGROUND: Foot drop secondary to L5 root injury is a rare complication associated with lumbar surgery. To date, it is still not clear whether intraoperative neuromonitoring can detect such an injury. CASE DESCRIPTION: A 54-year-old man who had had bilateral chronic L5 radiculopathy underwent L4-S1 lumbosacral decompression and fusion. During the surgery, the patient lose transcranial electrical motor evoked potential (tceMEPs) from left tibialis anterior (TA) at the time of L5-S1 intervertebral cage placement...
October 14, 2016: World Neurosurgery
Bethel C A Osuagwu, Leslie Wallace, Mathew Fraser, Aleksandra Vuckovic
OBJECTIVE: To compare neurological and functional outcomes between two groups of hospitalised patients with subacute tetraplegia. APPROACH: Seven patients received 20 sessions of brain computer interface (BCI) controlled functional electrical stimulation (FES) while five patients received the same number of sessions of passive FES for both hands. The neurological assessment measures were event related desynchronization (ERD) during movement attempt, Somatosensory evoked potential (SSEP) of the ulnar and median nerve; assessment of hand function involved the range of motion (ROM) of wrist and manual muscle test...
October 14, 2016: Journal of Neural Engineering
Ahmad Jabir Rahyussalim, Ifran Saleh, M Fajrin Armin, Tri Kurniawati, Ahmad Yanuar Safri
INTRODUCTION: Intraoperative neurophysiologic monitoring (IONM) had important role related to the complications in spinal surgery. Somatosensory Evoked Potential (SSEP), Transcranial electric Muscle Evoked Potentials (tceMEPs), and free run EMG are parameters used to asses functional integrity of the nervous system during surgical procedures. Once warning signal was recognized, surgeon have to make a precise decision to overcome that problem. PRESENTATION OF CASE: We present a 47-year old male with back pain due to compression fracture of thoracic vertebra T12 and lumbar vertebrae L1...
September 23, 2016: International Journal of Surgery Case Reports
Nicolas K Khattar, Robert M Friedlander, Rabih A Chaer, Efthymios D Avgerinos, Eric S Kretz, Jeffrey R Balzer, Donald J Crammond, Miguel H Habeych, Parthasarathy D Thirumala
BACKGROUND: Carotid endarterectomy (CEA) is the procedure of choice for reducing the risk of stroke in both symptomatic and asymptomatic carotid artery stenoses. Stroke is associated with significant morbidity and mortality peri-operatively (2-3 %). Our primary aim is to evaluate the etiology of these strokes after CEA and their impact on morbidity by comparing the length of stay in the hospital. METHODS: A total of 584 patients with documented neurological status evaluations who underwent CEAs were included in the study...
September 30, 2016: Acta Neurochirurgica
Laura M Muncie, Nathaniel R Ellens, Emeline Tolod-Kemp, Claudio A Feler, John S Winestone
OBJECTIVE This study is a retrospective case series involving C1-2 spinal cord stimulation in patients with complex regional pain syndrome (CRPS) under general endotracheal anesthesia. Currently, C1-2 paddle lead placement is an accepted practice, which provides effective cervical stimulation to ameliorate upper-extremity and sometimes lower-extremity symptoms experienced by patients with CRPS. However, this technique must be performed under general endotracheal anesthesia rather than in an awake or semiconscious state due to intraoperative safety concerns and patient comfort...
September 30, 2016: Journal of Neurosurgery. Spine
Jichao Ye, Mengjun Ma, Zhongyu Xie, Peng Wang, Yong Tang, Lin Huang, Keng Chen, Liangbin Gao, Yanfeng Wu, Huiyong Shen, Yuanshan Zeng
Nonhuman primate models of spinal cord injury (SCI) have been widely used in evaluation of the efficacy and safety of experimental restorative interventions before clinical trials. However, no objective methods are currently available for the evaluation of neural function in nonhuman primates. In our long-term clinical practice, we have used evoked potential (EP) for neural function surveillance during operation and accumulated extensive experience. In the present study, a nonhuman primate model of SCI was established in 6 adult cynomologus monkeys through spinal cord contusion injury at T8-T9...
2016: Scientific Reports
Richard Michael Page, Kelly Marrin, Chris Michael Brogden, Matt Greig
PURPOSE: To assess the residual fatigue response associated with the completion of two successive soccer-specific exercise protocols (SSEP). METHODS: Twenty male soccer players were pair-matched before completing SSEPs, interspersed by either 48 or 72 h. Outcome variables were measured every 15 min, and comprised uni-axial measures of PlayerLoad, mean (HR) and peak heart rate (HRpeak), blood lactate concentration, mean and peak (V˙O2peak) oxygen consumption, and rating of perceived exertion (RPE)...
July 4, 2016: Physical Therapy in Sport
Amer F Samdani, James T Bennett, Robert J Ames, Jahangir K Asghar, Giuseppe Orlando, Joshua M Pahys, Burt Yaszay, Firoz Miyanji, Baron S Lonner, Ronald A Lehman, Peter O Newton, Patrick J Cahill, Randal R Betz
BACKGROUND: Confidence in intraoperative neurophysiologic monitoring (IONM) data can allow scoliosis surgeons to proceed with surgery even after a monitoring alert, assuming the recovery of signals. We sought to determine the outcomes of surgical treatment of adolescent idiopathic scoliosis (AIS) after a notable IONM alert. METHODS: We identified 676 patients who underwent arthrodesis with use of IONM for the treatment of AIS. The patients were divided into 2 cohorts: those who experienced a lower-extremity IONM alert and those who did not...
September 7, 2016: Journal of Bone and Joint Surgery. American Volume
Serhat Pusat, Cahit Kural, Ilker Solmaz, Caglar Temiz, Yunus Kacar, Ozkan Tehli, Murat Kutlay, Mehmet Daneyemez, Yusuf Izci
AIM: Electrophysiological evaluation of the outcomes of spinal procedures is important for neurosurgeons. Somotosensorial evoqued potentials (SSEPs) are used for electrophysiological evaluation of tethered cord syndrome (TCS) and spinal intradural tumors (SIT). The aim of this study is to document the electrophysiological outcomes of surgery for TCS and SIT and to compare the results based on the preoperative diagnosis. MATERIAL AND METHODS: The data of 30 patients, who were operated for TCS and SIT between 2011 and 2013, were reviewed retrospectively...
February 5, 2016: Turkish Neurosurgery
Emine Taskiran, Sema Brandmeier, Erdinc Ozek, Ramazan Sari, Fatihhan Bolukbasi, Ilhan Elmaci
AIM: Intraoperative neurophysiological monitoring (IONM) monitors the functional integrity of critical neural structures by electrophysiological methods during surgery. Multimodality combines different neurophysiological methods to maximize diagnostic efficacy and provide a safety margin to improve the outcomes of spinal surgery. Our aim was to share our intraoperative monitoring experiences with patients who underwent surgery because of spinal cord pathologies between September 2013 and January 2015...
December 28, 2015: Turkish Neurosurgery
Baris Isak, Hatice Tankisi, Birger Johnsen, Kirsten Pugdahl, Nanna Brix Finnerup, Anders Fuglsang-Frederiksen
OBJECTIVE: Mild involvement of sensory nerves has been reported in previous studies in ALS patients. In this study, we assessed sensory pathways in ALS patients using laser evoked potentials (LEPs) and somatosensory evoked potentials (SSEPs). METHODS: We recruited 18 ALS patients and 31 healthy subjects. Neodymium-doped yttrium aluminium perovskite (Nd:YAP)-laser was used to evoke LEPs in upper (UE) and lower (LE) extremities. N1 and N2P2 potentials were obtained from contralateral insular cortex (T3 or T4) and vertex (Cz), respectively...
October 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
Shmuel Appel, Akiva Korn, Tali Biron, Kobi Goldstein, Nahshon Rand, Michael Millgram, Yizhar Floman, Ely Ashkenazi
INTRODUCTION: Intra-operative Neuro-Monitoring (IONM) is commonly used during cervical spine surgeries. Patient positioning with head extension is associated with risk of neurological damage. This study evaluates the frequency of loss of neurophysiological potentials during head positioning, the usefulness of head repositioning to restore the potentials, and the effect on neurological outcome. METHODS: We retrospectively reviewed consecutive cervical spine surgeries performed at the Israel Spine Center, Assuta Medical Center, during 2006-2013...
August 29, 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
Florian Roser, Florian H Ebner, Marina Liebsch, Marcos S Tatagiba, Georgios Naros
OBJECT: Suboccipital decompression and duraplasty is considered the treatment of choice for Chiari-I-malformation. Several studies have shown improvement of neurophysiological parameters during decompressive surgery in pediatric patients. However, there is no evidence of the beneficial role of intraoperative neuromonitoring in adults. METHODS: A total of 39 consecutive patients (25 female, age 41.1±14.5 years [mean±SD]) underwent suboccipital decompression for the treatment of symptomatic Chiari-I-malformation senior neurosurgeon and his team...
November 2016: Clinical Neurology and Neurosurgery
Parthasarathy D Thirumala, Samyuktha R Melachuri, Jaspreet Kaur, David Ninaci, Manasa K Melachuri, Miguel E Habeych, Donald J Crammond, Jeffrey R Balzer
STUDY DESIGN: This study examined the diagnostic accuracy of significant changes of somatosensory evoked potentials (SSEPs) to evaluate and predict post-operative neurological deficits after posterior cervical fusions (PCF). 846 eligible patients underwent PCF at the University of Pittsburgh Medical Center (UPMC), from 2010 to 2012. OBJECTIVE: to assess the specificity and sensitivity of intraoperative monitoring in predicting post-operative neurological deficits during PCF...
August 24, 2016: Spine
Natalie Domenick Sridharan, Rabih A Chaer, Partha D Thirumala, Jeffrey Balzer, Becky Long, Edith Tzeng, Michel S Makaroun, Efthymios D Avgerinos
BACKGROND: Late stroke and death rates are anticipated to be higher in patients undergoing carotid endarterectomy (CEA) compared with healthy counterparts. However, little is known regarding predictors other than the baseline comorbidities. We have recently shown that dual intraoperative somatosensory evoked potentials (SSEPs) and electroencephalography (EEG) monitoring improves the ability to predict perioperative strokes. We seek to determine if dual intraoperative monitoring (IOM) can further predict long-term strokes and death...
August 10, 2016: Annals of Vascular Surgery
Shujie Wang, Jianguo Zhang, Ye Tian, Jianxiong Shen
BACKGROUND CONTEXT: Intraoperative monitoring (IOM) is an essential method for preventing postoperative spinal deficits during posterior vertebral column resection (VCR) surgery for treatment severe spine deformities, but the IOM features directing at VCR procedures are rarely reported and need to be further clarified. PURPOSE: To evaluate an important surgical point that will lead to the IOM loss frequently, and then remind the surgeons to pay closely attention to the impending monitoring changes during posterior VCR surgery...
August 4, 2016: Spine Journal: Official Journal of the North American Spine Society
Susan H Morris, Jason J Howard, Ron El-Hawary
STUDY DESIGN: Randomized controlled study comparing the efficacy of intraoperative SSEPs versus TcMEPs as early indicators of neural compromise and predictors of post-operative function in a rat model of spinal cord compression. OBJECTIVE: To compare the relative efficacy of SSEPs and TcMEPs to detect spinal cord compromise and predict post-operative functional deficit following spinal cord compression. SUMMARY OF BACKGROUND DATA: There is controversy regarding the efficacy of SSEPs versus TcMEPs to detect intraoperative spinal cord compromise and predict functional outcomes...
August 5, 2016: Spine
Guillermo Martín-Palomeque, Antonio Castro-Ortiz, Pilar Pamplona-Valenzuela, Miguel Ángel Saiz-Sepúlveda, Lidia Cabañes-Martínez, Jaime R López
INTRODUCTION: Although large amplitude EPs are typically associated with progressive myoclonic epilepsy patients, giant EPs imply central nervous system (CNS) hyperexcitability and can be seen in various non-epileptic disorders. METHODS: We performed a retrospective chart review including history, physical examination, imaging and diagnostic studies of non-epileptic patients with large amplitude somatosensory evoked potentials (SSEPs) and visual evoked potentials (VEPs) during 2007-2013...
July 18, 2016: Journal of Clinical Neurophysiology: Official Publication of the American Electroencephalographic Society
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