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YOU are here : Home > Spinecare Topics > Options for Spine Treatments > Advancements in Spine Care and Spine Surgery
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Options for Spine Treatments
Advancements in Spine Care and Spine Surgery
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Advancements in Spine Care and Spine Surgery
The primary goal of intra-operative monitoring is to monitor surgical progress and to help identify neurological impairment during the operative procedure allowing for prompt intervention to reduce the risk for post-operative permanent deficits. The pre-operative nerve times and signals are recorded to serve as baseline of intra-operative changes.
There are two primary types of intra-operative neurophysiological monitoring. The first type uses techniques to identify acute damage or damage to the nervous system. Monitoring of the spinal nerve root and spinal cord function can be performed. This form of monitoring alerts the attending spine surgeon to possible nerve damage, and corrective action can be implemented in an attempt to prevent damage and further compromise. The second form of intra-operative nerve monitoring uses mapping techniques to identify critical structures in the spinal cord. Once these areas are identified, the spine surgeon attempts to avoid these structures to prevent neurological damage from occurring. Electrical mapping techniques may be used to help determine the viable boundaries around a tumor that is to be resected. There are two primary categories of intra-operative monitoring used during spine surgery that are somatosensory evoked potential studies and motor evoked potential monitoring.
Somatosensory-evoked potential (SEP) studies are used to evaluate the responses of sensory pathways to sensory or electrical stimuli applied to a selected area of the skin or nerve region. Intra-operative monitoring with sensory-evoked potentials is used to assess the functional integrity of central nervous system (CNS) pathways during operations that put the nerve root or spinal cord at risk for significant ischemia or traumatic injury. The basic principles of sensory-evoked potential monitoring involves identification of a neurological region at risk, selection and stimulation of a nerve that carries a signal through the at-risk region, and recording and interpretation of the signal at certain standardized points along the pathway during an operative procedure. While monitoring the nerve root or central neural pathway at risk, another sensory study is monitored as a control. Dermatomal somatosensory evoked potentials (DSEP) can be used to evaluate and monitor nerve root signal during spinal surgery. This form of neurophysiological monitoring is more specific to the nerve root than SEP studies.
Several different techniques are commonly used, including stimulation of a relevant peripheral nerve with monitoring from the scalp, from interspinous ligament needle electrodes, or from catheter electrodes in the epidural space.
Motor evoked potential studies involve stimulating the motor cortex and recording muscle responses from the arms, legs and face. This provides an opportunity to measure spinal cord responses prior to, during and after spinal surgery. There are two principle techniques used to stimulate the brain (motor cortex) during spine surgery. The first is transcutaneous electrical stimulation performed with needle electrodes inserted in the scalp over a designated area of the brain. The second method requires transcutaneous magnetic stimulation with a magnetic coil placed on the scalp over the selected area of the brain. These monitoring techniques used during spine surgery can help reduce the risk of otherwise undetected damage to the spinal cord and/or spinal nerve roots. There is a third method of stimulating the cortex. This requires direct stimulation to the brain typically performed during brain surgery.
There are two primary types of intra-operative neurophysiological monitoring. The first type uses techniques to identify acute damage or damage to the nervous system. Monitoring of the spinal nerve root and spinal cord function can be performed. This form of monitoring alerts the attending spine surgeon to possible nerve damage, and corrective action can be implemented in an attempt to prevent damage and further compromise. The second form of intra-operative nerve monitoring uses mapping techniques to identify critical structures in the spinal cord. Once these areas are identified, the spine surgeon attempts to avoid these structures to prevent neurological damage from occurring. Electrical mapping techniques may be used to help determine the viable boundaries around a tumor that is to be resected. There are two primary categories of intra-operative monitoring used during spine surgery that are somatosensory evoked potential studies and motor evoked potential monitoring.
Somatosensory-evoked potential (SEP) studies are used to evaluate the responses of sensory pathways to sensory or electrical stimuli applied to a selected area of the skin or nerve region. Intra-operative monitoring with sensory-evoked potentials is used to assess the functional integrity of central nervous system (CNS) pathways during operations that put the nerve root or spinal cord at risk for significant ischemia or traumatic injury. The basic principles of sensory-evoked potential monitoring involves identification of a neurological region at risk, selection and stimulation of a nerve that carries a signal through the at-risk region, and recording and interpretation of the signal at certain standardized points along the pathway during an operative procedure. While monitoring the nerve root or central neural pathway at risk, another sensory study is monitored as a control. Dermatomal somatosensory evoked potentials (DSEP) can be used to evaluate and monitor nerve root signal during spinal surgery. This form of neurophysiological monitoring is more specific to the nerve root than SEP studies.
Several different techniques are commonly used, including stimulation of a relevant peripheral nerve with monitoring from the scalp, from interspinous ligament needle electrodes, or from catheter electrodes in the epidural space.
Motor evoked potential studies involve stimulating the motor cortex and recording muscle responses from the arms, legs and face. This provides an opportunity to measure spinal cord responses prior to, during and after spinal surgery. There are two principle techniques used to stimulate the brain (motor cortex) during spine surgery. The first is transcutaneous electrical stimulation performed with needle electrodes inserted in the scalp over a designated area of the brain. The second method requires transcutaneous magnetic stimulation with a magnetic coil placed on the scalp over the selected area of the brain. These monitoring techniques used during spine surgery can help reduce the risk of otherwise undetected damage to the spinal cord and/or spinal nerve roots. There is a third method of stimulating the cortex. This requires direct stimulation to the brain typically performed during brain surgery.
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