Abstract
Study Design: Review of techniques and description of institutional clinical experience. Objective: To provide a historical review and description of key neuromonitoring concepts, focusing on neurogenic motor-evoked potentials and descending neurogenic evoked potentials, and to review the authors' experience with neuromonitoring techniques in children and adults undergoing spinal deformity surgery. Summary of Background Data: The original form of neuromonitoring, the Stagnara wake-up test, remains the "gold standard" for detecting true neurological deficits. Multiple newer modalities involving cortical and muscular monitoring, such as somatosensory evoked potentials and motor evoked potentials, have been developed and are widely used. Descending and neurogenic evoked potentials are becoming more common for neuromonitoring in patients undergoing spinal deformity surgery. Methods: A PubMed search for literature related to "neuromonitoring" was performed, and recent, as well as historical, articles were reviewed. Clinical experience regarding the use of neuromonitoring in adult and pediatric spinal deformity surgery was obtained from institutional experts. Results: Although not regularly used, the Stagnara wake-up test remains the gold standard for detecting neurological injury. Somatosensory evoked potentials measure signals transmitted from the periphery to the cortex and have historically been widely used but are limited by delay, poor localization, and the inability to detect damage to motor tracts. Motor evoked potentials continue to be used widely and measure muscular activity after cortical stimulation, but they are difficult to interpret in patients with underlying motor disorders and cannot be continuously monitored. Newer techniques such as descending neurogenic evoked potentials and neurogenic motor evoked potentials monitoring are used at some high-volume centers. Conclusions: Familiarity with the history of neuromonitoring in spinal deformity surgery and an understanding of the physiological systems used for neuromonitoring provide a framework from which spine surgeons can select appropriate monitoring for their patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | E1174-E1181 |
| Journal | Clinical Spine Surgery |
| Volume | 30 |
| Issue number | 9 |
| DOIs | |
| State | Published - 2017 |
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Keywords
- adult
- intraoperative neuromonitoring
- neurological injury
- pediatric
- spine deformity
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
- Clinical Neurology
Cite this
Intraoperative Neuromonitoring in Pediatric and Adult Spine Deformity Surgery. / Strike, Sophia; Hassanzadeh, Hamid; Jain, Amit; Kebaish, Khaled M; Njoku, Dolores B; Becker, Daniel; Ain, Michael; Sponseller, Paul David.
In: Clinical Spine Surgery, Vol. 30, No. 9, 2017, p. E1174-E1181.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Intraoperative Neuromonitoring in Pediatric and Adult Spine Deformity Surgery
AU - Strike, Sophia
AU - Hassanzadeh, Hamid
AU - Jain, Amit
AU - Kebaish, Khaled M
AU - Njoku, Dolores B
AU - Becker, Daniel
AU - Ain, Michael
AU - Sponseller, Paul David
PY - 2017
Y1 - 2017
N2 - Study Design: Review of techniques and description of institutional clinical experience. Objective: To provide a historical review and description of key neuromonitoring concepts, focusing on neurogenic motor-evoked potentials and descending neurogenic evoked potentials, and to review the authors' experience with neuromonitoring techniques in children and adults undergoing spinal deformity surgery. Summary of Background Data: The original form of neuromonitoring, the Stagnara wake-up test, remains the "gold standard" for detecting true neurological deficits. Multiple newer modalities involving cortical and muscular monitoring, such as somatosensory evoked potentials and motor evoked potentials, have been developed and are widely used. Descending and neurogenic evoked potentials are becoming more common for neuromonitoring in patients undergoing spinal deformity surgery. Methods: A PubMed search for literature related to "neuromonitoring" was performed, and recent, as well as historical, articles were reviewed. Clinical experience regarding the use of neuromonitoring in adult and pediatric spinal deformity surgery was obtained from institutional experts. Results: Although not regularly used, the Stagnara wake-up test remains the gold standard for detecting neurological injury. Somatosensory evoked potentials measure signals transmitted from the periphery to the cortex and have historically been widely used but are limited by delay, poor localization, and the inability to detect damage to motor tracts. Motor evoked potentials continue to be used widely and measure muscular activity after cortical stimulation, but they are difficult to interpret in patients with underlying motor disorders and cannot be continuously monitored. Newer techniques such as descending neurogenic evoked potentials and neurogenic motor evoked potentials monitoring are used at some high-volume centers. Conclusions: Familiarity with the history of neuromonitoring in spinal deformity surgery and an understanding of the physiological systems used for neuromonitoring provide a framework from which spine surgeons can select appropriate monitoring for their patients.
AB - Study Design: Review of techniques and description of institutional clinical experience. Objective: To provide a historical review and description of key neuromonitoring concepts, focusing on neurogenic motor-evoked potentials and descending neurogenic evoked potentials, and to review the authors' experience with neuromonitoring techniques in children and adults undergoing spinal deformity surgery. Summary of Background Data: The original form of neuromonitoring, the Stagnara wake-up test, remains the "gold standard" for detecting true neurological deficits. Multiple newer modalities involving cortical and muscular monitoring, such as somatosensory evoked potentials and motor evoked potentials, have been developed and are widely used. Descending and neurogenic evoked potentials are becoming more common for neuromonitoring in patients undergoing spinal deformity surgery. Methods: A PubMed search for literature related to "neuromonitoring" was performed, and recent, as well as historical, articles were reviewed. Clinical experience regarding the use of neuromonitoring in adult and pediatric spinal deformity surgery was obtained from institutional experts. Results: Although not regularly used, the Stagnara wake-up test remains the gold standard for detecting neurological injury. Somatosensory evoked potentials measure signals transmitted from the periphery to the cortex and have historically been widely used but are limited by delay, poor localization, and the inability to detect damage to motor tracts. Motor evoked potentials continue to be used widely and measure muscular activity after cortical stimulation, but they are difficult to interpret in patients with underlying motor disorders and cannot be continuously monitored. Newer techniques such as descending neurogenic evoked potentials and neurogenic motor evoked potentials monitoring are used at some high-volume centers. Conclusions: Familiarity with the history of neuromonitoring in spinal deformity surgery and an understanding of the physiological systems used for neuromonitoring provide a framework from which spine surgeons can select appropriate monitoring for their patients.
KW - adult
KW - intraoperative neuromonitoring
KW - neurological injury
KW - pediatric
KW - spine deformity
UR - http://www.scopus.com/inward/record.url?scp=85032257550&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032257550&partnerID=8YFLogxK
U2 - 10.1097/BSD.0000000000000388
DO - 10.1097/BSD.0000000000000388
M3 - Article
VL - 30
SP - E1174-E1181
JO - Clinical Spine Surgery
JF - Clinical Spine Surgery
SN - 2380-0186
IS - 9
ER -