The Neurodiagnostic journal
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Previously intraoperative neurophysiological monitoring (IONM) has not been used along with a computer based navigation system for en bloc resection of a sacral Ewing sarcoma. In order to improve the post-operative neurological outcome of the patient we decided to include IONM in our procedure. A partial or complete resection of a sacral tumor may result in the loss of neurological functions due to close proximity of vascular, neural, and visceral structures. ⋯ This case report demonstrates that intraoperative neurophysiological monitoring was useful in identifying and reversing impending nerve injury during sacrectomy surgery. Significant changes were seen in ulnar and posterior tibial somatosensory evoked potentials (SSEPs). We recommend that IONM should be considered for safe margin en bloc sacral tumor resection and prevention of injury to the sacral root and brachial plexus.
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Case Reports
Intraoperative monitoring may prevent neurologic injury in non-myelopathic patients undergoing ACDF.
The efficacy of spinal cord monitoring for patients undergoing anterior cervical discectomy and fusion (ACDF) as indicated for radiculopathy without myelopathy is debated in the literature. The reported rate of complications is low for this procedure. ⋯ In both cases, changes in the electrophysiological data prompted intervention and prevented a permanent neurological deficit. Based on these observations we recommend spinal cord monitoring using sensory and motor evoked potentials to prevent new deficits in non-myelopathic patients undergoing ACDF surgery.
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Distinguishing obstructive sleep apnea from central apnea depends upon accurate measure of chest and abdominal movement. American Academy of Sleep Medicine (AASM) polysomnography guidelines recommend the use of respiratory inductive plethysmography (RIP) belts but not piezoelectrode (PE) belts for measuring chest and abdominal movements. To compare these two sensors, we measured the signal amplitude for 10 RIP belts and 10 PE belts stretched by mechanical distraction across six distances (2.5 to 15.0 centimeters) and replicated 10 times for each belt. ⋯ Signals from PE belts highly correlated with the distance of distraction (r = 0.96 to 0.99) and the RIP belts (r = 0.98 to 0.99). These results suggest that PE belts perform similarly to RIP belts at distraction distances up to 10.0 centimeters. Further testing on biological models is needed to determine if PE belts are a suitable alternative for RIP belts in polysomnography.
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Sleep is integral to the health and well-being of all people. Sleep disorders are on the rise and affect millions of people in America. Misconceptions about sleep are prevalent, and the negative effects of poor sleep on society are underrepresented. ⋯ The beginnings of these solutions lie in the hands of healthcare workers and educational institutions. Interventions in the form of questionnaires have been validated as effective in determining a person's risk of sleep apnea. The STOP-BANG questionnaire is one such intervention that may be useful by allied health professionals to assist in patient screening of sleep apnea.