medigraphic.com
ISSN 1405-8790 (Print)

2002, Number 2-4

<< Back Next >>

Rev Mex Med Fis Rehab 2002; 14 (2-4)

Trans-surgical neurophysiologic evaluation in patients with cervical stenosis

Castillo HM, Escobar CR, Lona PS, Reyes SA, Rosales LM, Miramontes V

Language: Spanish
References: 21
Page: 37-40
PDF size: 44.72 Kb.


ABSTRACT

In order to evaluate the root nervous integrity in patients with cervical estenosis, after surgery, we performed a clinical study in 20 patients from National Orthopedic Institute, 12 females, 8 males, with age rate 23-84 years. They were tested with somatosensory evoked potentials (SEPs) of the median and ulnar nerve and performed a dynamic electromyography (EMG) of myotomes of the affected roots. Results: The average latencies don’t show significant changes, the amplitudes improved 10%. On clinical evaluation only a patient referred pain, two patients referred pain and hypoestesia. On the final trans-surgical evaluation they showed a diminished amplitude of SEPs of 50%. On dynamic EMG a patient showed a mechanical irritation of C6 at the moment of manipulation of the root, without data of alteration of the root, at present asymptomatic. Conclusions: The SEPs as a unic method does not shows immediate, adecuated and complet information of the incidence of a neurologic severe injury, and performed together with dynamic EMG it helps to diminish incidence of neurologic injury. It should be considerated as a important help during surgery, because the dynamic EMG confirms the root level that was being manipulated and provides immediate information of root irritation and avoiding more neurological damage, and bringing out the possibility of adequate surgical decompression of the root.


REFERENCES

  1. Owen J, Toleikis R. Nerve root monitoring. Ann Neurophisiol 1997; 12: 4-11.

  2. Calancie B, Harris W. “Threshold-level” multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal motor tracts: description of method and comparison to somatosensory evoked potential monitoring. J Neurosurg 1988; 88: 457-470.

  3. Veilleux M, Dube JR. Monitoring of cortical evoked potentials during surgical procedures on the cervical spine. Mayo Clin Proc 1987; 62: 256-264.

  4. Epstein N, Danto J, Nardi D. Evaluation of intraoperative somatosensory-evoked potential monitoring during 100 cervical operations. Spine 1993; 18(6): 737-747.

  5. Barry DT. AAEM minimonograph # 36: Basic concepts of electricity and electronics in clinical electromyography. Muscle & Nerve 1991; 14: 937-946.

  6. Daube JR. AAEM minimograph #11: needle examination in clinical electromyography. Muscle & Nerve 1991; 14: 3-14.

  7. Beatty R, McGuuirre P. Continuous intraoperative electromyographic recording during spinal surgery. J Neurosurg 1995; 82: 401-405.

  8. Meyer PR, Cotler BH, Gireesan GT. Operative neurological complications resulting from thoracic and lumbar spine internal fixation. Clin Orthop 1988; 237: 125-131.

  9. Whitlle IR, Johnston IH, Besser M. Recording of spinal somatosensory evoked potentials for intraoperative spinal cord monitoring. J Neurosurg 1986; 64: 601-12.

  10. Wilber RG, Thompson GH. Postoperative neurological deficits in segmental spinal instrumentation. J Bone Joint Surg (Am) 1984; 66: 1178-1187.

  11. Johnson EW, Melvin JL. Value of electromyography in lumbar radiculopathy. Arch Phys Med Rehabil 1971; 52: 239-243.

  12. Izzo KL, Aravabhumi S. Clinical electromyography. Principles and practice. Clin Podiatry Med Surg 1990; 7: 179-194.

  13. Englr GL, Spielholz NI, Bernhard WN. Somatosensory evoked potentials during Harrington instrumentation for scoliosis. J Bone Surg (Am) 1978, 60ª: 528-532.

  14. Dinner DS, Luders H, Intraoperative spinal somatosensory evoked potential monitoring. J Neurosurg 1986; 65: 807-814.

  15. Sebel PS, Erwin CW, Neville WK. Effects of halotane and enfluorane on far and near field somatosensory evoked potentials. Br J Anaesth 1987; 59: 1492-1496.

  16. Chistyakov A, Soustiel J. Motor and somatosensory conduction in cervical myelopathy and radiculopathy. Spine 1995; 20(19): 2135-2140.

  17. Kai Y, Owen J. Relationship between evoked potentials and clinical status in spinal cord ischemia. Spine 1994; 19(10): 1162-1168.

  18. Welch W, Rose R. Evaluation with evoked and spontaneous electromyography during lumbar instrumentation: a prospective study. J Neurosurg 1997; 87: 397-402.

  19. Satomi k, Okuma T. Level diagnosis of cervical myelopathy using evoked spinal cord potentials. Spine 1988; 13(11): 1217-1224.

  20. Shinomiya K, Okamoto A. Rognosticating study for cervical myelopathy using evoked spinal cord potentials. Spine 1990; 15(10): 1053-1057.

  21. Hironobu K, Senzoku F. Valuation of cervical cord function using spinal evoked potential from surface electrode. Spine 1992; 17(3): 339-344.




2020     |     www.medigraphic.com