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Hyper Smash

Thursday, August 16, 2007

Neuromuscular Scoliosis?- Intraoperative Neuromonitoring!!

Michael G Fehlings* and Michael O Kelleher


*Suite 4WW-446, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada


This article has no abstract so we have provided the first paragraph of the full text.

  • The avoidance of iatrogenic neurological injury is of paramount importance during spinal surgery, and multimodality intraoperative monitoring using a combination of MEPs, SSEPs and electromyographic (EMG) signals is increasingly used in this setting.1, 2 During corrective procedures for neuromuscular scoliosis, however, the successful application of intraoperative monitoring is a challenge, particularly in the most severely deformed and neurologically compromised patients.3 Difficulties in obtaining reliable baseline recordings of conventional (cortical and subcortical) SSEPs and transcranial
    MEPs in patients with neuromuscular scoliosis has prompted the use of an epidural electrode to record spinal SSEPs and evoke neurogenic MEPs.

You do Spine surgery and Do not monitor nerves..Why?

Neuro monitoring (a.k.a.: Neurophysiologic Intraoperative Monitoring) may be one of the most exciting and important €œold€ innovations to come into spine and neuro surgery in decades.

Think of it, what surgeon would dare operate without blood gas monitoring? Or blood pressure monitoring?
So why operate without nerve monitoring?

We recently talked with Debra Zacharko, who teaches neuro monitoring for NeuroMatrix in Atlanta. She described a case in which one of her clients scheduled a straightforward laminectomy and declined to use neuro monitoring. €œSo, I told him that I'€™d perform the monitoring for free,€ said Zacharko, €œand when I showed him the wave form tapes

he was amazed to see how much nerve irritation there is even in a simple laminectomy.€