Foot Drop: -Case Review!

Check the case review section!

Special Reviews on Cancer Cell Biology, JCB!

An interesting special reviews edition on Cellular mechanism of Cancer has been published by JCB. This reviews collection provides the most updated research reports and experimental results on cancer that can be of interest to researchers, pharma companies and clinicians. 

"Special Collection of Reviews on Cancer Cell Biology". 


We are pleased to present this collection of reviews on the cell biology of cancer. Basic science provides the foundation for progress in cancer biology, and we are delighted to highlight reviews discussing fundamental cell biological discoveries and how these latest advances can be harnessed therapeutically for translational development. Learn about the cellular mechanisms protecting genome stability at sites of stalled DNA replication. 

Read about the relationship between signaling and endocytosis in cancer, and how this can enhance cancer cell survival, migration, and proliferation. 

Tumor tissues exhibit altered mechanical properties\
Here is: Link and further details.

Whole Brain Atlas: This Online Whole Brain Atlas is a Treat for Advanced Clinicians and Researchers

Brain Structure and Anatomy:- 

The whole brain atlas created or compiled by two Harvard MDs Keith and Alex is a great collection of various brain areas or for that matter all levels and depths of whole brain.

From Whole Brain Atlas

Their digital work took me back to my graduate days, where at numerous occasions made cumbersome brain sections, whole brain sections, meticulous works through whole night or some time it ran through days of non stop brain sectioning, those were either fresh or fixed brains. What you will experience here on their collection is advanced imaging graphic presentation. Nevertheless the experience is reminiscent of my days in the research lab looking at Cross/Sagital or sections of brain as well as other planes through the entire brain.

The Whole Brain Atlas

Here are couple of Scnshots from their site:

Their work and data is a must visit for advanced Neurophysiologists, Radiologists and all the spine, neck and brain surgeons, besides medical students planning to specialize in Brain and Spine. Here is the Link:Website/Url. 

This digital wealth of information of whole brain structure and anatomy is a comprehensive work using various imaging such as MRI, CT and SPECT besides other anatomical tracing techniques put together to reveal the entire brain, along with images there are also videos such as video of the "Circle of Willis" and various vascular structures supplying brain areas, as I traveled through their site, it was like feasting euphorically!.

As you browse through the contents, there is so much to add besides whole brain atlas, the images revealing abnormal brain areas in various neurodegenerative/neurological disease is something clinicians can benefit a lot.
More updates after I review the whole site.....!!

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TBI or Sports Brain Injuries-Diagnosis without Opening the Skull?

My Editorial and Review on Recent Trends in Brain Damage is next, in the mean time, this is the latest news about Traumatic Brain Injruy (TBI) and how Spreading Depolarization can be tapped using neuromonitoring and how that can be used to understand and interpret the brain damage without opening the skull, what I meant is without a neurosurgery?.

LLIF-Lateral Lumbar Interbody Fusion Procedure

This particular video taken during the Lateral Lumbar Interbody Fusion procedure at UPMC by Dr.Kanter and his team is a treat to watch the intricacy of surgical steps during lateral Spine procedure, you might have been into the OR or  probably done neuromonitoring for procedures including various lumbar level fusion procedures, but if there is no live camera equipped in the OR,  it is often difficult to know where exactly is the surgeon is and what is he/she is doing at a particular stage of the procedure, it will be just a guess work and that is not acceptable in the medical/health care field (all the stakeholders inside the OR must know exactly about the procedure) and that is not how things can go inside the Operating Room. Every team member from Anesthesiologist to Neurophysiologist to nurses must know every step of the way what exactly the surgeon is doing in order to help or figure out if there is any issue arise during surgical procedure. Unfortunately, most ORs are not equipped with the video transmission inside the OR or if there is one they normally do not use it (but in most neurosurgery ORs they do use). Those professionals who work inside the OR must acquaint themselves with surgical  steps of the surgeons, one way to do is watch it live or recorded one, or a demo before participating in such surgical procedure. It will provide a deeper understanding and realistic perception of how a particular procedure is done, with that knowledge handy, it will be more appropriate to provide feed back to the surgeon on neurophysiology or anesthesia or other relevant modalities to be monitored inside the OR. Even the X-Ray tech's must know the basics (most often that is not the case), ironically the cell saver and other tech's who come inside the OR have no clue about anything in the OR except that little machine collecting the blood?. Knowing exactly what the surgeon is doing every step of the way inside the OR provides a lot more close to a  realistic perception than reading it from a book or listening someone describe it. For those graduates or tech's who have not seen the details of this procedure, this is a good one to watch. Thanks to Dr.Kanter and his colleagues from UPMC for presenting this procedure so well.

Epilepsy, what is going on in the Epilepsy Research and is there any Advancement?. Nature Journals Special Issue..

Nature Publishing Group (the owner and publisher of worlds popular "Nature") has just published a special issue, featuring the story of Epilepsy covering aspects why this disease is still not well understood and what do the worlds govt's and funding agencies must do, meaning why there is not much funding is allocated to Epilepsy research considering more than 50Million people world wide are affected by more than a dozen types of Epilepsy?. Yes, that is certainly a valid question and reasonable expectation from various govts and funding agencies. That is just the beginning of this special issue, named under the category "Outlook". To run this special issue and program, Nature has been awarded a special "Independent Education Grant by Sunovion Pharmaceuticals Inc.
There is also another recent Special issue on Neuroscience published somewhere in late 2013, about which I will write later. This Editorial is to provide some idea to researchers, clinicians and people who are working in the field of Epilepsy that this might be the best issue to update yourself about the field and the recent developments in Epilepsy. Ofcourse, those patients and relatives who can understand the science behind Epilepsy, who are wondering what is really going on and what are the possible treatments available, might be a good place to check.

Mike May, the contributing Editor has given a brief summary of the entire issue, a good place to start reading this issue: http://www.nature.com/nature/journal/v511/n7508_supp/full/511S1a.html

Note: This special is issue is only open to public or non subscribers upto October, so better read before it will be taken of the shelf or go get a copy of it.

Interesting research reports presented by the field's top scientists/researchers, clinicians and more.  I will go through the entire issue pretty much cover to cover, but before I spend time, I thought to share this for those who may not have heard about this special issue. The first Chapter or section begins with the background information about the basics of Epilepsy the origin of Excitation or Excitement, and there are sections on genetic basis, drug treatment modalities as well as technologies that can detect the types and details of the epilepsy. Other sections regarding the Epidemiology and types of this disease, management and social issues including the misunderstanding and  tabo's of epilepsy, sociology of it, and the issue ends with what is food got to do with Epilepsy or what food intake might be the best for people with seizure or epileptic episodes. Overall, seems like a great issue with a comprehensive knowledge about the disease, complexities and its future. I hope I can write a real Editorial with scientific temperament when I am done reading the whole issue.......

From Nature's Cover Image Content:

• Epilepsy is a common neurological condition that affects 50 million people worldwide. For many patients, medication helps reduce seizure frequency; for drug-resistant epilepsy, treatments include diet therapy and neurosurgery. Although discussed and feared for millennia, progress towards understanding epilepsy has been slow — even with help from modern genetic and neurological analysis. Stigmatization of people with epilepsy continues in certain parts of the world and though lack of funding limits epilepsy research, new ways to treat and manage seizures are on the horizon.
  Free full access
  Cover Art: Nik Spencer

Yumen City of China is Sealed off to outside world?, Did China just make a bizzare decision or a informed Right one as a Precaution?.

Updates!: One would expect more news or updates on this sealed off city in China, nothing came out after the initial news?...Whatever news came out on this issue was in the month of July?.

Plague is treatable disease, diligence and scientific approach is a must but not panicky and seal off of a city. Here is a NIH site with a treatment info:

Image on the left: This Flea is a carrier of Plague Bacteria.

at the bottom is the image of the bacteria: Yersinia Pestis
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PubMed Health: Plague Treatment

People with the plague need immediate treatment. If treatment is not received within 24 hours of when the first symptoms occur, death can result.
Antibiotics such as streptomycin, gentamicin, doxycycline, or ciprofloxacin are used to treat plague. Oxygen, intravenous fluids, and respiratory support usually are also needed.
Patients with pneumonic plague should be strictly isolated from caregivers and other patients. People who have had contact with anyone infected by pneumonic plague should be watched carefully and given antibiotics as a preventive measure.

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City of Yumen, China

The following news piece is not related to our field of Neuromonitoring but to disease, medicine and general health care. The way this disease and a case of death has been dealt with a country as large as China is bit unusual and rather bizarre, why?.

What exactly is happening in Yumen City right now:

MSN News: The 30,000 people living in Yumen in the northwestern province of Gansu are not being allowed to leave, and police at roadblocks on the perimeter of the city are telling motorists to find alternative routes, state broadcaster China Central Television (CCTV) said. The 38-year-old victim died last Wednesday, the report said, and had been in contact with a dead marmot, a small furry animal which lives on grasslands and is related to the squirrel. "The city has enough rice, flour and oil to supply all its residents for up to one month," the report added. "Local residents and those in quarantine are all in stable condition."

"Live Science" in its latest news report published a piece (news headline and link posted below) about single case of "Plague" death in a small city called Yumen in China. According to the news sources, there is only one Plague death and no other reported case of death or ill (or perhaps the China media or govt did not say so?). Why would a country like China which has good research and science facility and medical facility will take a rather unscientific and scary decision to seal off the town/city. 

As per CDC and experts in the field, this is a treatable disease if the patient or victim is brought to the right treatment facility in the earlier stages of infection. Hope some Chinese experts in the field of infectious disease inform the authorities about this treatments. 

If it is a Bubonic Plague and if there is treatment available, why did the man died?, and why the city authorities sealing off the city?. It seems the man who died of Plague was interacted with more than 100s of people in that town, that is still not a reason to seal off an entire town, especially the kind of plague infected the dead person was Bubonic Plague, a less infectious and not transferable form of plague. Unless, he had died of other variants of Plague that can be transferred from one human to another, why would such a extreme decision to seal off the city was taken. Or are there more infections that news is not yet out to the public?. This is exactly why I call this Bizzare, this kind of actions will scare the people and create a fear, that is not at all inevitable given the circumstances of this disease, infact the US authorities say every now and then they come across rare cases of plague right here in USA!!. We don't seal off a town or city here...the patient gets the attention of right type of experts and doctors to provide treatment.

On a second thought, I am inclined to think the China is taking every precaution they can because of their past history of plague that devastated the nations.

Note: This Editorial is not to blame China or say insensitive thing about the nation or its actions, it is finally left to them to deal with the situation as it is appropriate, but a thorough scientific approach is a must.

Chinese Officials Seal Off 'Plague' City, Puzzling US Experts

by Rachael Rettner, LiveScience Staff Writer   |   July 22, 2014 06:20pm ET

EEG technique and Treatment of Rolandic Epilepsy treatment?.

Looking at the EEG patterns periodically at certain time difference, could be week or month in between, Yamanashi and his colleague found that there is a repetitive high frequency EEG waveform abnormality that can be used to strategies for treatment?. Although, it is a brief study on small number of children's, EEG recordings and the abnormal waveform morphology is one of the or the only way to ascertain what to do with such epileptic patient, actually, while referring to the recent reviews in this field, I found this compelling review article   by Dr.Markand, MD (see at the bottom after the Yamanashi's work).

What was their research model and study is about:

A total of ten children between the ages of three and ten with recurrent seizures and 12 patients aged between four and seven years who experienced isolated seizures were enrolled in the study, with seizure recurrence and prolonged high-frequency EEG paroxysm data being correlated by the scientists.
Repeated EEG recordings were taken every three months, with clinical and EEG follow-up performed for four or more years. It was discovered that seizure recurrence and extended periods of high-frequency paroxysmal EEG abnormalities for more than 6 months after onset were significantly linked.

New study shows how EEG can aid rolandic epilepsy treatment

Posted May 21 2014 in epilepsy in children and its treatment

A new study from Japan has shed light on how electroencephalogram (EEG) techniques can be useful in aiding the treatment of patients with rolandic epilepsy.

This form of epilepsy is generally associated with favourable outcomes, with a moderate proportion of cases characterised by isolated seizure events, meaning continuous treatment need only be considered only for those affected by frequent seizures.

As such, the new research from the University of Yamanashi aimed to identify EEG criteria related to seizure recurrence in rolandic epilepsy, in order to help guide treatment strategies for those in this patient group.


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The review article that I mentioned above:

a good read to get the background idea of how the neurophysiologist, neurologist or clinicians can discern the EEG patterns:

Seminars in Neurology

Pearls, Perils, and Pitfalls In the Use of the Electroencephalogram

Omkar N. Markand, MD, FRCPC

 An EEG is the most common and most useful test performed in evaluating patients suspected of epilepsy. There are many areas where an EEG has unique contributions. The value of an EEG lies in the fact that it not only shows specific ictal discharges during a clinical seizure but also characteristic epileptiform abnormalities in a high proportion of epileptic patients even in the interictal period. Furthermore, an EEG may be the only test demonstrating focal abnormalities responsible for the patient's epileptic seizures. Specific patterns in the EEG make it possible to classify the seizure type, which is an essential prerequisite to institute proper antiepileptic medication. An EEG is indispensable for the diagnosis of nonconvulsive epileptic status presenting as prolonged "twilight" state or a prolonged episode of abnormal behavior. In a patient with bizarre motor activity, the recording of an EEG during such an episode may be the only way to establish whether the abnormal behavior is due to an epileptic seizure or a nonepileptic event, physiologic or nonphysiologic. Finally, the EEG is indispensable to localize the epileptogenic (seizure producing) zone before resective surgery (excision of the epileptogenic zone) is undertaken in a patient with medically refractory focal epilepsy.

Epilepsy: Drug Resistent Focal Epilepsy & Surgical Resection treatments, two Epilepsia Reports

Brain and Spine, 2014 Research Reports:

Fig from-Link: Human Epilepsy Patterns, focal epilepsy,

The following two new research reports published in Epilepsia journal [quoted Epilepsy current]might be of interest to those Epilepsy doctors and professionals, ofcourse to Neurophysiologists and long term intraoperative monitoring field.

Quoted: Current Literature In Clinical Science
Are HFOs Still UFOs? The Known and Unknown About High Frequency Oscillations in Epilepsy Surgery

High-Frequency Oscillations, Extent of Surgical Resection, and Surgical Outcome in Drug-Resistant Focal Epilepsy.

Haegelen C, Perucca P, Chatillon CE, Andrade-Valenca L, Zelmann R, Jacobs J, Collins DL, Dubeau F, Olivier A, Gotman J.

Epilepsia 2013;54:848–857.

PURPOSE: Removal of areas generating high-frequency oscillations (HFOs) recorded from the intracerebral electroencephalography
(iEEG) of patients with medically intractable epilepsy has been found to be correlated with improved surgical outcome. However, whether differences exist according to the type of epilepsy is largely unknown. We performed a comparative assessment of the impact of removing HFO-generating tissue on surgical outcome between temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). We also assessed the relationship between the extent of surgical resectionand surgical outcome.

Read the full abstract at: http://www.aesnet.org/files/dmfile/epcu_13.6_273_ClinicalCommentary_Jobst.pdf#!
And the Full article at Epilesia journal.

Ripple Classification Helps to Localize the Seizure-Onset Zone in Neocortical Epilepsy.

Wang S, Wang IZ, Bulacio JC, Mosher JC, Gonzalez-Martinez J, Alexopoulos AV, Najm IM, So NK.

 Epilepsia 2013;54:370–376.

PURPOSE: Fast ripples are reported to be highly localizing to the epileptogenic or seizure-onset zone (SOZ) but may not be readily found in neocortical epilepsy, whereas ripples are insufficiently localizing. Herein we classified interictal neocortical ripples by associated characteristics to identify a subtype that may help to localize the SOZ in neocortical epilepsy. We hypothesize that ripples associated with an interictal epileptiform discharge (IED) are more pathologic,since the IED is not a normal physiologic event.

For full abstract and article, refer as the previous.

The Lancet Paper on "Spinal Cord Damage" -some improvement in Movements of Paralyzed Patients

The patient seems to have had the following type of spinal cord damage:
 The Lancet Quote "An individual three years post C7-T1 subluxation presented with a complete loss of clinically detectable voluntary motor function and partial preservation of sensation below the T1 cord segment" end of Quote.

In this interesting Lancet paper on neuronal recovery/functional recovery, the authors claims they have noticed significant improvement of Paralyzed patients after implant and electrical stimulation. This new positive results was not achieved by the same group in their own earlier clinical studies,  authors say "we have not seen such a result in their earlier research studies". 

Spinal cord stimulation studies been done both in lab rats as well as paralyzed patients. This is the latest report on paralyzed patients responding to stimulation with visible movements, it is interesting but we have long way to go to have a wholesome or meaningful treatment of spinal cord damages, it all comes to the extent of damage, and severity of neural paths that are severed by accidents......if the integrity of both afferent and efferent pathways are preserved with mild or minor damages, the recovery can be significant, in cases were more than 50% percent damages or even more severe, that determines the possibility of any recovery. In either case, it is good to read some results. And, when it is published in The Lancet, got to be little credible to listen to the news?..

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Lancet. 2011 June 4; 377(9781): 1938–1947.

Published online 2011 May 19. doi:  10.1016/S0140-6736(11)60547-3

Effect of Epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study

Findings

Epidural stimulation enabled the human lumbosacral spinal circuitry to dynamically elicit full weight-bearing standing with assistance provided only for balance for 4·25 minutes in a subject with a clinically motor complete SCI. This occurred when using stimulation at parameters optimized for standing while providing bilateral load-bearing proprioceptive input. Locomotor-like patterns were also observed when stimulation parameters were optimized for stepping. In addition, seven months after implantation, the subject recovered supraspinal control of certain leg movements, but only during epidural stimulation.

Orthopedic Surgeon Spyros Pranos Medical Fraud, 250 Law suits?. a Doctor who Faked and Botched Surgery, what an Evil?

Latest Update:
ABC News:  
Judgment Day for Surgeon Who Admitted to Fake Surgeries

March 7, 2014

By LIZ NEPORENTLiz Neporent More from Liz »via Good Morning America

Dr. Spyros Panos pleaded guilty to performing fake and negligent surgeries more than 250 times.

Handout

An orthopedic surgeon who admitted to botching and faking thousands of surgeries over a five-year period was sentenced today to four-and-a-half years in federal prison for one count of health care fraud.

Dr. Spyros Panos, who practiced medicine in Poughkeepsie, N.Y., pleaded guilty to one count of health care fraud last October. In addition to his sentence, he was fined $250,000 and ordered to pay the government $5 million as restitution for false and overstated Medicare charges. He was also ordered to surrender all licenses to practice medicine in states where it had not already been suspended. 

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Orthopedic surgeon Dr.Pranos seems to have  had detailed OP notes about treatments to his patients but that never took place?, hmmm....it seems he scheduled as large as 22 surgeries in a single day?, now he is under scrutiny and more than 250 law suits been filed.

Orthopedic Surgeon Sued Over Fraudulent Cases

Spyros Panos, MD, who practiced in suburban Dutchess County, N.Y., north of New York City, is said to have scheduled as many as 22 surgeries in a day, according to his former patients' attorneys. He has reportedly failed to adequately cement joint replacement components, implanted incorrect components and carried out an unneeded rotators cuff repair while ignoring a fractured clavicle.

Full Article: Link

Nerve Conduction Tests (NCV) in Guillian- Barre Syndrome, what is new?.

Clinical Neurophysiology
Journal Article in Press

Two sets of nerve conduction studies may suffice in reaching a reliable electrodiagnosis in Guillain–Barré syndrome

Nortina Shahrizaila et al..
► The existing electrodiagnostic criteria in Guillain–Barré syndrome are unreliable when applied at the initial stages of disease onset. ► Nerve conduction studies performed at two time courses, within 2weeks and 3–8weeks, may better reflect the final electrodiagnosis of Guillain–Barré syndrome. ► The pattern of recovery in Guillain–Barré syndrome is heterogeneous and validation of the current Erasmus Guillain–Barré syndrome outcome score in different patient populations is required.

 

Abstract :Recent studies have advocated the use of serial nerve conduction studies (NCS) in the electrodiagnosis of Guillain–Barré syndrome (GBS). The current study aims to elucidate when and how frequent NCS can be performed to reflect the disease pathophysiology.

No more LinkedIn, No Facebook or other social sites, Beware their Breach is a yet another fraud and drama to sell you!?

Beware of LinkedIn, Facebook, Twitter, Yahoo, Google and for that matter even Microsoft:

These companies constantly sell and buy contacts, all the so called breach is not really a breach, or hacking or cyber security issue starts and end with them, they use these to con, sell things, create fake news for promotional purposes etc, you know what that means?:

I have been monitoring all these so called social and professional networking websites such as LinkedIn, Facebook, google and others. I am sure you all noticed the number of such websites reporting breach and leak of members details or hacking of their sites and it continues without any end to this menace.

I realized, our personal information and connections are at serious risk in these bottom feeding companies hands, so as of today, I will be terminating my LinkedIn, two days ago, I have seen lots of contacts been either stolen from other sites and LinkedIn published it on my page. Do you remember on the top right corner a streaming lists will show up everyday, "You may Know these People", have you ever noticed how they get and from where they get those lists, every time you visit or spent few min, you will see several of them are your friends, or colleagues or you know personally?, how do you think LinkedIn get those details, think?.

In my case, I believe either they breached and stolen contacts from my google or outlook contacts or the google would have sold them for a handsome bucks, so do the facebooks leak. Most of this so called breach or leaks are not really leaks but they purposefully create news awareness so that they can get away from any law suits or Feds going after them, because leak or breach is an accident?. wow..

So keep my email contacts, please do not use any of the google, facebook or linked in, use these following secure emails to get in touch with me or network with me. Thanks

Contact: use the contact form to get in touch with me on this topic or any other in this Blog.
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IONM: Neurological Testing or Neurophysiological Divining? J. G. Salamy, Ph.D.

Editorial Link:

Dr Joe Salamy writes a thought provoking and insightful Editorial Review about Intraoperative NeuroMonitoring, where do we stand?, what do we have to do to bring in new approach and newer technologies to avoid the IONM field become a stagnant one?..

IONM: Neurological Testing or Neurophysiological Divining? 

J. G. Salamy, Ph.D.  

VERTECz: surgical neurophysiology, Las Vegas, Nevada 

2012 All Rights Reserved

Email: 

Summary

During the last three decades IONM has followed an objective probability-based clinical model whichfocused attention almost exclusively upon the detection of specific events.  IONM practices, however, donot neatly conform to those of conventional clinical testing procedures.  It is suggested herein that futureefforts be directed toward developing additional models which elucidate the dynamic and subjectivequalities of IONM and recognize the importance of sequences and their influence upon decision making. Heretofore, the temporal and linguistic aspects of IONM have been largely ignored.  It is proposed that weexamine IOMN as an ongoing interactive process, and develop new tools to help accomplish this task.

For full Article , visit this Special Editorial column under the tabs: or click the following link

http://neuromonitoring1.blogspot.com/p/special-editorials.html

Etomidate during surgical procedures, a clinical study?.

A study about Etomidate usage in patients undergoing certain surgical procedures?.

The authors of this clinical study made a claim that Etomidate is linked worst post surgical outcomes and including risks of death? but other expert anesthesiologist argued that the study is not conclusive (not a definitive study?), well a combination of anesthetics when used caution must be exercised, this is for anesthesiologists to keep in mind when they make their decision to use what anesthesia combination or regiment can make a safe outcome.

Etomidate Linked to Worse Post-op Outcomes vs. Propofol

Risk for death more than doubled for critically ill in retrospective study

by Michael Vlessides

Washington—Anesthesiologists tempted to use etomidate instead of propofol to induce anesthesia in critically ill patients might think twice after considering the results of a retrospective analysis by researchers at Cleveland Clinic. The analysis concluded that noncardiac patients given etomidate were two to three times more likely than those given propofol to die within 30 days.
“Although etomidate is sometimes used for general anesthesia induction in critically ill patients, the drug is known to cause prolonged adrenal impairment by blocking cortisol release,” said Ryu Komatsu, MD, a resident at the Ohio institution. “As we might suspect, worse outcomes have been reported in association with etomidate use in critically ill patients. However, the potential link between etomidate and worsened postoperative outcomes has not been systematically studied in general surgical patients.”

Spine Journal: Article on Safe Thoracic Pedicle screw placedment

Thoracic pedicle screw placements especially the upper thoracic levels do not have specific  muscle innervation making it difficult to test pedicle screws, in other words it is not as discrete as you can do a test on for example Deltoid (Cervical) or Tibialis anterior (lumbar). The following article though

Spine (Phila Pa 1976). 2012 

Safe pedicle screw placement in thoracic scoliotic curves using t-EMG: stimulation threshold variability at concavity and convexity in apex segments.

de Blas G, Barrios C, Regidor I, Montes E, Burgos J, Pizá-Vallespir G, Hevia E.

Source

Department of Clinical Neurophysiology, Hospital Ramón y Cajal, Madrid, Spain.

Abstract

STUDY DESIGN:

A cross-sectional study of nonconsecutive cases (level III evidence).

OBJECTIVE:

In a series of young patients with thoracic scoliosis who were treated with pedicle screw constructs, data obtained from triggered electromyography (t-EMG) screw stimulation and postoperative computed tomographic scans were matched to find different threshold limits for the safe placement of pedicle screws at the concavity (CC) and convexity (CV) of the scoliotic curves. The influence of the distance from the medial pedicle cortex to the spinal cord on t-EMG threshold intensity was also investigated at the apex segment.

SUMMARY OF BACKGROUND DATA:

Whether the t-EMG stimulation threshold depends on pedicle bony integrity or on the distance to neural tissue remains elusive. Studying pedicle screws at the CC and CV at the apex segments of scoliotic curves is a good model to address this issue because the spinal cord is displaced to the CC in these patients.

Mar 15;37(6):E387-95. doi: 10.1097/BRS.0b013e31823b077b.

IONM news

Some updates:  http://drmunisneuromonitoring.blogspot.com/

Benefit of Intraoperative IONM and Expenses?...

The risks are minimal but they are real, and when you are not using the advanced technology and knowledge available to assess and safeguard the patients from risks of nerve damage or paralysis, your care is flawed and pretty dangerous, if you can spent 25 thousands for surgery and do not use Neuromonitoring that might cost another thousand or two, and you think that is cost effective, then something wrong with such ideas. Bringing safety inside OR must be the top priority of an operating surgeon (performing surgeon). There are several vascular or neurological complications happen during spine surgical procedures that may not be identified timely if you do not use neuromonitoring techniques, and when you find out after the surgery, it is too late.  

How to be a Better Surgeon, apart from Surgereries what else can play important role to be the best surgeon?.

Professor Steve Bogdewic talks about Surgeons and how to be a better surgeon!...

Watch the video:  Link

Dr. George W. Copeland Professor of Family Medicine

Indiana University, Indianapolis

Dr. Stephen P. Bogdewic is the Dr. George W. Copeland Professor of Family Medicine and the Executive Associate Dean for Faculty Affairs and Professional Development at Indiana University School of Medicine. Dr. Bogdewic received his Ph.D. in Adult Education and Organizational Development from the University of North Carolina. Dr. Bogdewic has served as President of the Society of Teachers of Family Medicine (STFM) and was the recipient of the Society’s highest teaching award, the Excellence in Education Award.

Dr. Bogdewic’s scholarly interests include faculty development, leadership development, and qualitative research methodologies. Office: (317) 278-5461; E-mail: bogdewic@iupui.edu