The value of transcranial motor-evoked potentials and free-running electromyography in surgery for cervical disc herniation

Fotakopoulos, George; Alexiou, George Α.; Pachatouridis, Dimitrios; Karagiorgiadis, Dimitrios; Konitsiotis, Spyridon; Kyritsis, Athanasios P.; Voulgaris, Spyridon

doi:10.1016/j.jocn.2012.01.048

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…Transient bursts can be induced by mild traction in free-running EMG but are reversible. [ 13 ] Therefore, it was concluded that there was no traction or irritation that could have led to irreversible nerve injury.…”

Section: Discussionmentioning

confidence: 99%

Removal of schwannoma from the psoas muscle with intraoperative neurophysiological monitoring: A case report

Yoo,

Kim,

Yang

et al. 2024

Medicine

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Rationale: The incidence of a schwannoma within the psoas muscle is rare, and only a few cases have been reported. The surgical approach to removing schwannomas present in the psoas muscle is challenging because of its anatomical proximity to the lumbar plexus. Patient concerns: A 31-year-old man experienced right lower back pain and anterolateral thigh numbness for 2 months. Diagnosis: Magnetic resonance imaging of the patient’s lumbar spine revealed a mass lesion, which was radiologically diagnosed as a well-demarcated schwannoma. Interventions: The patient underwent surgery for excision of the schwannoma in the right psoas muscle at the second to fourth lumbar vertebrae levels. During surgery, intraoperative neurophysiological monitoring modalities, free-running and triggered electromyography and evoked potentials, from the target muscles were recorded. Outcomes: There was no neurotonic discharge corresponding to neuronal injury. Compound motor nerve action potential was detected in the triggered electromyography of muscles around the medial margin of the tumor. However, direct integration of the motor nerve was not observed in the intra-tumor region. Lessons: We report that schwannoma removal in the psoas muscle, which is adjacent to the lumbar plexus, can be safely performed using intraoperative neurophysiological monitoring.

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Section: Discussionmentioning

confidence: 99%

Removal of schwannoma from the psoas muscle with intraoperative neurophysiological monitoring: A case report

Yoo,

Kim,

Yang

et al. 2024

Medicine

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“…The method is not specific and it is sensitive to changes in anesthesia and temperature, pre existing neurological deficit, electrical artifacts, and electrode positioning [8]. EMG combined with intermittent TcMEP has been suggested as a better way to monitor the motor pathways [75].…”

Section: Monitoring During Spinal Surgerymentioning

confidence: 99%

“…Several authors used invasive methods of intraoperative visual evoked response registration with encouraging results [75,[84][85][86][87][90][91][92].…”

Section: Ep Monitoring During Surgery On the Brain Vep (Cn Ii)mentioning

confidence: 99%

Neurophysiological Monitoring during Surgery on the Central Nervous System: The Role of Evoked Responses

Soghomonyan

2015

IJAR

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Neurosurgical, orthopedic and vascular interventions may be associated with an inherent risk of ischemia and structural damage to the central nervous system. Along with other modalities used to monitor the intraoperative nervous function, registration of evoked responses is intended to provide real-time feedback about the functional integrity of the central nervous system and help to prevent avoidable trauma during surgery. In this review, the principal indications and limitations of monitoring various evoked responses during surgery on the brain and spinal cord are discussed. Current approaches, recent advances and problems associated with intraoperative rhomboid fossa mapping, cranial nerve stimulation and electrooculographic monitoring are presented as well. The authors discuss the effects of general anesthesia on evoked responses and possible ways to avoid signal variability during registration. It is emphasized that only with close cooperation between neurosurgeons, anesthesiologists and neurophysiologists it will be possible to maximize the benefits of intraoperative monitoring of evoked responses and avoid misinterpretation of the results.

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“…[17] Those demonstrating a 41% increase in Tc MEP amplitude exhibited excellent postoperative results, while those with 11% increase in Tc MEP amplitude had only fair results [Table 1]. …”

Section: Intraoperative Monitoring In Cervical Surgerymentioning

confidence: 99%

The need to add motor evoked potential monitoring to somatosensory and electromyographic monitoring in cervical spine surgery

Epstein

2013

Surg Neurol Int

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Intraoperative neural monitoring (IONM), utilizing somatosensory evoked potentials (SEP) and electromyography (EMG), was introduced to cervical spine surgery in the late 1980's. However, as SEP only provided physiological data regarding the posterior cord, new motor deficits were observed utilizing SEP alone. This prompted the development of motor evoked potential monitoring (MEP) which facilitated real-time assessment of the anterior/anterolateral spinal cord. Although all three modalities, SEP, EMG, and MEP, are routinely available for IONM of cervical spine procedures, MEP are not yet routinely employed. The purpose of this review is to emphasize that MEP should now routinely accompany SEP and EMG when performing IONM of cervical spine surgery. Interestingly, one of the most common reasons for malpractice suits involving the cervical spine, is quadriparesis/quadriplegia following a single level anterior cervical diskectomy and fusion (ACDF). Previously, typical allegations in these suits included; negligent surgery, lack of informed consent, failure to diagnose/treat, and failure to brace. Added to this list, perhaps, as the 5th most reason for a suit will be failure to monitor with MEP. This review documents the value of MEP monitoring in addition to SEP and EMG monitoring in cervical spine surgery. The addition of MEP0 should minimize major motor injuries, and more accurately and reliably detect impending anterior cord deterioration that may be missed with SEP monitoring alone.

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The value of transcranial motor-evoked potentials and free-running electromyography in surgery for cervical disc herniation

Cited by 7 publications

References 20 publications

Removal of schwannoma from the psoas muscle with intraoperative neurophysiological monitoring: A case report

Removal of schwannoma from the psoas muscle with intraoperative neurophysiological monitoring: A case report

Neurophysiological Monitoring during Surgery on the Central Nervous System: The Role of Evoked Responses

The need to add motor evoked potential monitoring to somatosensory and electromyographic monitoring in cervical spine surgery

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