The Spine Journal
Volume 6, Issue 6, Supplement , Pages S212-S224 , November 2006

Intraoperative neurophysiologic monitoring: focus on cervical myelopathy and related issues

  • Vincent J. Devlin, MD

      Affiliations

    • Geisinger Medical Center, Department of Orthopedic Surgery, M.C. 21-30, 100 North Academy Avenue, Danville, PA 17822, USA
    • Corresponding Author InformationCorresponding author. Geisinger Medical Center, Department of Orthopedic Surgery, M.C. 21-30, 100 North Academy Avenue, Danville, PA 17822. Tel.: (570) 271-6541; (570) 271-5872.
    • ,
  • Paul A. Anderson, MD

      Affiliations

    • University of Wisconsin Hospitals, 600 Highland Avenue, Suite K4-738, Madison, WI 53792, USA
    • ,
  • Daniel M. Schwartz, PhD, DABNM

      Affiliations

    • Surgical Monitoring Associates, 25 Bala Avenue, Suite 105, Bala Cynwyd, PA 19004, USA
    • ,
  • Robin Vaughan, PhD, DABNM

      Affiliations

    • Neurophysiology Incorporated, 5395 Ruffin Road, #102, San Diego, CA 92123, USA

References 

  1. Schwartz DM, Sestokas AK. The use of neuromonitoring for neurological injury detection and implant accuracy. In:  Vaccaro AR,  Regan JJ,  Crawford AH,  Benzel EC,  Anderson DG editor. Complications of pediatric and adult spinal surgery. New York: Marcel Decker; 2002;p. 159–171
  2. Vauzelle C, Stagnara P, Jouvinrous P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop. 1973;93:173–178
  3. Nuwer MR, Dawson EG, Carlson LG, et al. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalogr Clin Neurophysiol. 1995;96:6–11
  4. Schwartz DM, Drummond DS, Schwartz JA, et al. Neurophysiological monitoring during scoliosis surgery: a multimodality approach. Semin Spine Surg. 1997;10:97–111
  5. Padberg AM, Bridwell KH. Spinal cord monitoring: current state of the art. Orthop Clin North Am. 1999;30:407–433
  6. Owen JH. Cost efficacy of intraoperative monitoring. Sem Spine Surg. 1997;9:348–352
  7. Powers SK, Bolger CA, Edwards MB. Spinal cord pathways mediating somatosensory evoked potentials. J Neurosurg. 1982;57:472–478
  8. May DM, Jones SJ, Crockard HA. Somatosensory evoked potential monitoring in cervical surgery: identification of pre-and intraoperative risk factors associated with neurological deterioration. J Neurosur. 1996;85:566–573
  9. Ben-David B, Taylor G, Haller G. Anterior spinal fusion complicated by paraplegia: a case report of a false-negative somatosensory evoked potential. Science. 1986;12:536–539
  10. Gugino LD, Aglio LS, Segal ME, Gonzalez AA, Kraus KH. Use of transcranial magnetic stimulation for monitoring spinal cord motor pathways. Sem Spine Surg. 1997;9:315–336
  11. Isley MR, Balzer JR, Pearlman RC, Zhang XF. Intraoperative motor evoked potentials. Am J End Technol. 2001;41:266–338
  12. Calancie B, Harris W, Broton JG, Alexeeva N, Green BA. “Threshold-level” multipulse transcranial electrical stimulation of motor cortex for intraoperative monitoring of spinal cord motor tracts: description of methods and comparison to somatosensory evoked potential monitoring. J Neurosurg. 1998;88:457–470
  13. Hilibrand AS, Schwartz DM, Sethuraman V, Vaccaro AR, Albert TA. Comparison of transcranial electric motor and somatosensory evoked potential monitoring during cervical surgery. J Bone Joint Surg. 2004;86A:1248–1253
  14. Leis AA, Zhou HH, Mehta M, Harkey HL, Paske WC. Behavior of the H-reflex in humans following mechanical perturbation or injury to rostral spinal cord. Muscle & Nerve. 1996;19:1373–1382
  15. Deletis V. The “motor” inaccuracy in neurogenic motor evoked potentials. Clin Neurophysiol. 2001;112:1365–1366
  16. Schwartz DM, Drummond DS, Ecker ML. Influence of rigid spinal instrumentation on the neurogenic motor evoked potential. J Spinal Disord. 1996;9:43–45
  17. Minaham RE, Sepkuty JP, Lesser RP, Sponseller PD, Kostuik JP. Anterior spinal cord injury with preserved neurogenic “motor” evoked potentials. Clin Neurophysiol. 2001;112:1442–1450
  18. Toleikis JR, Skelly JP, Carlvin AO, Burkus JK. Spinally elicited peripheral nerve responses are sensory rather than motor. Clin Neurophysiol. 2000;111:736–742
  19. Calancie B, Lebwohl N, Madsen P, Klose KJ. Intraoperative evoked EMG monitoring in an animal model: a new technique for evaluating pedicle screw placement. Spine. 1992;17:1229–1235
  20. Bose B, Wierzbowski LR, Sestokas AK. Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar surgery. Spine. 2002;27:1444–1450
  21. Gunnarsson T, Krassioukov AV, Sarjeant R, Fehlings MG. Real-time continuous intraoperative electromyographic and somatosensory evoked potential recordings in spinal surgery: correlation of clinical and electrophysiologic findings in a prospective, consecutive series of 213 cases. Spine. 2004;29:677–684
  22. Holland NR, Kostuik JP. Continuous electromyographic monitoring to detect nerve root injury during thoracolumbar scoliosis surgery. Spine. 1997;22:2547–2550
  23. Raynor BL, Lenke LG, Kim Y, et al. Can triggered electromyography thresholds predict safe thoracic pedicle screw placement?. Spine. 2002;27:2030–2035
  24. Shi YB, Binette M, Martin WH, Pearson JM, Hart RA. Electrical stimulation for intraperative evaluation of thoracic pedicle screw placement. Spine. 2003;28:595–601
  25. Djurasovic M, Dimar JR, Glassman SD, Edmonds HL, Carreon LY. A prospective analysis of intraoperative electromyographic monitoring of posterior cervical screw fixation. J Spinal Disord Tech. 2005;18:515–518
  26. Fan D, Schwartz DM, Vaccaro AR, Hilibrand AS, Albert TJ. Intraoperative neurophysiologic detection of iatrogenic C5 nerve root injury during laminectomy for cervical compression myelopathy. Spine. 2002;27:2499–2502
  27. Holland NR, Lukaczyk TA, Riley LH. Higher electrical stimulus intensities are required to activate chronically compressed nerve roots: implications for intraoperative electromyographic pedicle screw testing. Spine. 1998;23:223–227
  28. Dai L, Ni B, Yuan W. Radiculopathy after laminectomy for cervical compression myelopathy. J Bone Joint Surg Br. 1998;80:846–849
  29. Sasai K, Saito T, Akagi S. Clinical study of cervical radiculopathy after laminoplasty for cervical myelopathy. J Jpn Orthop Assoc. 1995;69:1237–1247
  30. Tsai RY, Yang RS, Nuwer MR, Kanim LE, Delamarter RB, Dawson EG. Intraoperative dermatomal evoked potential monitoring fails to predict outcome from lumbar decompression surgery. Spine. 1997;22:1970–1975
  31. O'Brien MF, Lenke LG, Bridwell KH, et al. Evoked potential monitoring of the upper extremities during thoracic and lumbar spinal deformity surgery: a prospective study. J Spinal Disord. 1994;7:277–284
  32. Labrom RD, Hoskins M. Reilly CW et al. Clinical usefulness of somatosensory evoked potentials for detection of brachial plexopathy secondary to malpositioning in scoliosis surgery. Spine. 2005;30:2089–2093
  33. Schwartz DM, Drummond DS, Hahn M, Ecker ML, Dormans JP. Prevention of positional brachial plexopathy during surgical correction of scoliosis. J Spinal Disord. 2000;13:178–182
  34. Branston NM, Symon L, Cortical EP. Blood flow and potassium changes in experimental ischemia. In:  Barber C editors. Evoked potentials. Baltimore: University Park Press; 1980;p. 527–553
  35. Schuber A, Tod MM, Luerssen TG, Hicks GE. Loss of intraoperative evoked responses during dorsal column surgery associated with isolated postoperative sensory deficit. J Clin Monit. 1987;3:277–281
  36. Zornow MH, Grafe MR, Tybor C, Swenson MR. Preservation of evoked potentials in a case of anterior spinal artery syndrome. Electroenceph Clin Neurophysiol. 1990;77:137–139
  37. Berthold CH, Carlstedt T, Corneliuson O. Anatomy of the nerve root at the central-peripheral transitional region. In:  Dyck PJ,  Thomas PK,  Lambert EH,  Bunge R editor. Peripheral neuropathy. Philadelphia: WB Saunders; 1984;p. 156–217
  38. Banoub M, Tetxlaff JE, Shuber J. Pharmacologic and physiologic influences affecting sensory evoked potentials. Anesthesiology. 2003;99:716–737
  39. Haghighi SS, Madsen R, Gree KD, et al. Suppression of motor evoked potentials by inhalation anesthetics. J Neurosurg Anesth. 1990;2:73–78
  40. Perlik SJ, VanEgeren R, Fisher MA. Somatosensory evoked potential surgical monitoring: observations during combined isoflurane–nitrous oxide anesthesia. Spine. 1992;17:273–276
  41. Calancie B, Klose KJ, Baier S, Green BA. Isoflurane-induced attenuation of motor evoked potentials caused by electrical motor cortex stimulation during surgery. J Neurosurg. 1991;74:897–904
  42. Schwartz DM, Schwartz JA, Pratt RE, Wierzbowski LR, Sestokas AK. Influence of nitrous oxide on posterior tibial nerve cortical somatosensory evoked potentials. J Spinal Disord. 1997;10:80–86
  43. Sloan TB. Anesthetic effects on electrophysiologic recordings. J Clin Neurophysiol. 1998;15:217–226
  44. Sloan TB, Heyer EJ. Anesthesia for intraoperative monitoring of the spinal cord. J Clin Neurophysiol. 2002;19:430–443
  45. Haghi S, Mads R, Green K, Weston PF, Boyd SG, Hall GM. Suppression of motor evoked potentials by inhalation anesthetics. J Neurosurg Anesth. 1990;2:73–76
  46. Jellinek D, Platt M, Jewkes D, Symon L. Effects of nitrous oxide on motor evoked potentials recorded from skeletal muscle in patients under total intravenous anesthesia with intravenously administered propofol. Neurosurgery. 1991;29:558–562
  47. Scheufler KM, Zentner J. Total intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data. J Neurosurg. 2002;96:571–579
  48. Schwartz DM, Sestokas AK. A systems-based algorithmic approach to intraoperative neurophysiological monitoring during spine surgery. Semin Spine Surg. 2002;14:136–145
  49. Schwartz DM, Sestokas AK, Turner LA, Morledge DE, DiNardo AA, Beachum SG. Neurophysiological identification of iatrogenic neural injury during complex spine surgery. Sem Spine Surg. 1998;10:242–251
  50. Thuet ED, Padberg AM, Raynor BL, et al. Increased risk of postoperative neurologic deficit for spinal surgery patients with unobtainable intraoperative evoked potential data. Spine. 2005;30:2094–2103
  51. Schwartz DM, Wierzbowski LR, Fan D, Sestokas AK. Surgical neurophysiologic monitoring. In:  Vaccaro AR,  Betz RR,  Aeidman SM editor. Principles and practice of spine surgery. Philadelphia: Mosby; 2003;p. 115–126
  52. Schwartz DM. Intraoperative neurophysiological monitoring during cervical spine surgery. Op Tech Orthop. 1996;6:6–12
  53. Epstein NE, Danto JD, Nardi D. Evaluation of intraoperative somatosensory evoked potential monitoring during 100 cervical operations. Spine. 1993;18:737–747
  54. Kombos T, Suess O, DaSilva C, Ciklaterlerlio O, Nobis V, Brock M. Impact of somatosensory evoked potential monitoring on cervical surgery. J Clin Neurophysiol. 2003;20:122–128
  55. Jones SJ, Buonamassa S, Crockard HA. Two cases of quadriparesis following anterior cervical discectomy, with normal perioperative somatosensory evoked potentials. J Neurol Neurosurg Psych. 2003;74:273–276
  56. Sebastian C, Raya JP, Ortega M, Olalla E, Lemos V, Romero R. Intraoperative control by somatosensory evoked potentials in the treatment of cervical myeloradiculopathy. Eur Spine J. 1997;6:316–323
  57. Sloan TB, Ronai AK, Koht A. Reversible loss of somatosensory evoked potentials during anterior cervical spinal fusion. Anesth Analg. 1986;65:96–99
  58. Taunt CJ, Sidhu KS, Andrew SA. Somatosensory evoked potential monitoring during anterior cervical discectomy and fusion. Spine. 2005;30:1970–1972
  59. Kitagawa H, Itoh T, Takano H, et al. Motor evoked potential monitoring during upper cervical spine surgery. Spine. 1989;14:1078–1083
  60. Gokaslan ZL, Samudrala S, Deletis V, Wildrick DM, Cooper PR. Intraoperative monitoring of spinal cord function using motor evoked potentials via transcutaneous epidural electrode during anterior cervical spinal surgery. J Spinal Dis. 1997;10:300–303
  61. Calancie B, Harris W, Brindle GF, Green BA, Landy HJ. Threshold-level repetitive transcranial electrical stimulation for intraoperative monitoring of central motor conduction. J Neurosurg. 2001;95:161–168
  62. Beatty RM, McGuire P, Moroney JM, Holladay FP. Continuous intraoperative electromyographic recording during spinal surgery. J Neurosurg. 1995;82:401–405
  63. Jellish WS, Jensen RL, Anderson DE, Shea JF. Intraoperative electromyographic assessment of recurrent laryngeal nerve stress and pharyngeal injury during anterior cervical spine surgery with Caspar instrumentation. J Neurosurg. 1999;(2 suppl):170–174
  64. Vaccaro AR, Schwartz DM. Neurophysiologic monitoring during cervical spine surgery. In:  Benzel EC,  Currier BL,  Dormans JP, et al. editor. The cervical spine. 4th ed.. Philadelphia: Lippincott Williams & Wilkins; 2005;p. 238–244
  65. Sakaura H, Hosono N, Mukai Y, Ishii T, Yoshikawa H. C5 palsy after decompression surgery for cervical myelopathy. Spine. 2003;28:2447–2451
  66. Chiba K, Toyama Y, Matsumoto M, Maruiwa H, Watanabe M, Hirabayashi K. Segmental motor paralysis after expansive open-door laminoplasty. Spine. 2002;27:2108–2115
  67. Sasi K, Saito T, Akagi S, Kato I, Ohnari H, Ida H. Preventing C5 palsy after laminoplasty. Spine. 2003;28:1972–1977
  68. Jimenez JC, Sani S, Braverman B, Deutsch H, Ratliff JK. Palsies of the fifth cervical nerve root after cervical decompression: prevention using continuous intraoperative electromyography monitoring. J Neurosurg Spine. 2005;3:92–97
  69. Bose B, Sestokas AK, Schwartz DM. Neurophysiological monitoring of spinal cord function during instrumented anterior cervical fusion. Spine J. 2004;4:202–207

 FDA device/drug status: not applicable.Nothing of value received from a commercial entity related to this manuscript.

PII: S1529-9430(06)00224-5

doi: 10.1016/j.spinee.2006.04.022

The Spine Journal
Volume 6, Issue 6, Supplement , Pages S212-S224 , November 2006

Article Tools

* Image Usage & Resolution