Median Nerve SSEP:- Is there a relationship between Median Nerve SSEP & Level of Spinal Cord Injury?

This case study was conducted by the American Spinal Cord Injury Association (ASIA) on patients with Quadriplegia. The question asked was is there a relationship between median nerve SSEP changes and level of spinal cord injury?.

The answer is yes, neuromonitoring of median nerve SSEPs conducted on 14 quadriplegic patients and 8 normal individuals. Amplitude and latency analysis of waveforms N9, N13 and N20 was conducted. N9 responses were present in all the patients and normal subjects, both amplitude and latency were similar in both groups.

On the other hand, N13 was absent in Quadriplegia patients?
N20 was absent in C5 patients with Quadriplegia? but it was present in C6-7 patients, though the amplitudes were decreased with normal latency. Did you notice these waveform changes in your recording?.

Read further:

Original Article

Spinal Cord (2009) 47, 372–378; doi:10.1038/sc.2008.147; published online 20 January 2009

Relationship between median nerve somatosensory evoked potentials and spinal cord injury levels in patients with quadriplegia

M I F de Arruda Serra Gaspar¹, A Cliquet Jr^2,3, V M Fernandes Lima⁴ and D C C de Abreu¹

Methods:

Fourteen individuals with quadriplegia and 8 healthy individuals were evaluated. Electrophysiological assessment of the median nerve was performed by evoked potential equipment. The injury level was obtained by ASIA. N₉, N₁₃ and N₂₀ were analyzed based on the presence or absence of responses. The parameters used for analyzing these responses were the latency and the amplitude. Data were analyzed using mixed-effect models.

First Spinal Cord Endoscope Surgery Conducted in Iran

Can you imagine in this 21st century with so much of medical knowledge and medical care a first spinal endoscope surgical procedure is done on Oct 14, 2008?. A first spinal surgery in Iran, wow....finaly a surgical procedure to help patients with back or spinal problems is introduced in Iran by an American spine surgeon?.

Iran News Page One > Iran News First Spinal Cord Endoscope Surgery Conducted in Iran Oct 15, 2008 Iranian.ws The first spinal cord endoscope surgery was conducted in Iran, yesterday morning, by Professor John Chio, head of California Vertebrarium Research Center. Shedding light on details of such a surgery, Chio said: “During this surgery the tissues are not cut and the muscles are placed aside with highly delicate tools in order to reach the spinal cord and to lower disc pressure. Meanwhile, in order to stitch the wound, laser is used.” He added that in this surgery the patient does not bleed and therefore blood transfusion does not take place. The surgeon further underlined that the patient can leave three hours after surgery, resuming his social life within six days and commencing his athletic activities within three weeks. “The operation is also economically justified,” he added. He further said that one of his main goals is to train Iranian physicians, stressing that Iranian physicians are intelligent and can easily learn this operation.

4th and 5th Cervical Laminae-Acute Hemiparesis?

This interesting article published in the "Journal of Bone and Joint Surgery" describes spinal cord injuries at the C4-C5 level caused by a serious head-on vehicle collision in a 18 year old teenager. The accident resulted in invagination of C4-C5 laminae into the spinal canal and also fractures leading to hemiparesis?. Surgical intervention of laminectomy, fusion and stabilization with instrumentation resulted in recovery from right sided weakness and recovery of full neurological functions.

Traumatic invagination of the fourth and fifth cervical laminae with acute hemiparesis
U. R. Hähnle, L. Nainkin
From the University of the Witwatersrand, Johannesburg, South Africa

The patient was initially treated by skeletal traction (3 kg) applied using
Crutchfield tongs. As the neurological deficit did not recover
during the following week operation was undertaken.
Through a posterior approach, exposing the laminae and
lateral masses from C3 to C6, the invagination of the right
laminae of the C4 and the C5 vertebrae was confirmed. All
other posterior elements such as the facet joints, ligamentum
flavum, interspinous ligaments and spinous processes
were intact. The fracture at C2 was not exposed.
Reduction of the invaginated laminae was achieved by
gentle traction on the spinous processes. Mild flexion of the
neck helped to maintain the reduction. As the neck was
extended there was a tendency for the laminae to reinvaginate.
Transverse wiring of the two involved spinous processes
was undertaken with tension towards the left-sided
lateral masses to maintain the position of the reduced
laminae.
Adequate decompression was confirmed on a postoperative
CT scan (Figs 3a and 3b).