Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society
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J Clin Neurophysiol · Apr 2012
EditorialNIOM for spinal deformity surgery: there's more than one way to skin a cat.
This was a 23-year retrospective study of 3436 consecutive pediatric orthopedic spinal surgery patients between 1995 and 2008. ⋯ The combined use of somatosensory evoked potentials, transcranial electric motor evoked potentials, descending neurogenic evoked potentials, and electromyography monitoring allowed accurate detection of permanent neurologic status in 99.6% of 3436 patients and reduced the total number of permanent neurologic injuries to 6.
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J Clin Neurophysiol · Apr 2012
ReviewUtility of electromyography for nerve root monitoring during spinal surgery.
In addition to potential spinal cord injury, spinal surgery carries a risk of damage to spinal nerve roots, which could result in sensory or motor deficit. Both spontaneous and triggered electromyography (sEMG and tEMG, respectively) have been employed to reduce the risk of these deficits. This article reviews the theory and best practice of electromyographic monitoring for spinal surgery, the evidence supporting its use for various types of spine surgery, and finally, suggestions for future directions to improve knowledge and advance electromyographic monitoring of spinal nerves.
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J Clin Neurophysiol · Apr 2012
ReviewIntraoperative use of somatosensory-evoked potential in monitoring nerve roots.
Different intraoperative neuromonitoring modalities (mixed-nerve somatosensory-evoked potential [M-SSEP], dermatomal somatosensory-evoked potential [D-SSEP], compound motor-evoked potential [CMEP], electromyography [EMG], and the Hoffmann reflex [H-reflex]) have been developed for early detection of nerve root injury, for timely revision, and for damage reduction. In this study, we discuss the advantages and disadvantages of M-SSEP and D-SSEP by reviewing experimental evidence from animal models and clinical practice.
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J Clin Neurophysiol · Apr 2012
ReviewUtility of motor evoked potentials for intraoperative nerve root monitoring.
There is no entirely satisfactory way to monitor nerve root integrity during spinal surgery. In particular, standard free-running electromyography carries a high false-positive rate and some false-negative rate of injury. Stimulated electromyography to direct root stimulation can only be done intermittently, and roots are often inaccessible. ⋯ Only amplitude reduction warning criteria have been studied, but no percentage cutoff consensus has emerged, and this approach is troubled by response variability. There is some evidence that MEPs might reduce false electromyographic results. In conclusion, muscle MEPs could compliment electromyography but seem unlikely to completely solve the problem of nerve root monitoring.
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J Clin Neurophysiol · Apr 2012
Ulnar neuropathy in hansen disease: clinical, high-resolution ultrasound and electrophysiologic correlations.
To assess the relationship between the cross-sectional area (CSA) of the ulnar nerve by ultrasound (US) with clinical and electrophysiologic findings in Hansen ulnar neuropathy. ⋯ In leprosy patients, a positive correlation exits between the presence of motor weaknesses of the ulnar nerve innervated muscles, sonographically thickening of the ulnar nerve, and motor conduction slowing of the ulnar nerve at the BE-AE segment. In addition, US provided information on nerve morphologic alterations regarding the echo texture and location of nerve enlargement.