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... ... @@ -266,6 +266,7 @@ 266 266 267 267 268 268 269 + 269 269 = Section IV.4.4: New frontiers of intraoperative EMG application = 270 270 271 271 (% class="FreeForm" style="text-align: justify; line-height: 200%;" %) ... ... @@ -272,3 +272,140 @@ 272 272 (% style="font-family: ~"Times New Roman~",~"serif~";" %)There appears to be a correlation between the muscles with objective EMG activation during intraoperative monitoring and the subjective paresthesia obtained postoperatively, as described in Tables 1-3. Thus, this may be explored to generate a precise model of paresthesia coverage and create a functional dermatomal mapping of perceived stimulation threshold after the surgery. Furthermore, the EMG activation threshold may be a reliable predictor of the patient’s perceived paresthesia threshold. It has been the author’s experience that EMG activation correlated with pain control at amplitudes lower than the paresthesia threshold (i.e. subthreshold stimulation), and that occasionally persistent EMG activation intra- and postoperatively may be seen lasting as long as 15 minutes after the stimulation is discontinued. These patients typically respond extremely well to the stimulation therapy. It seems likely that these patients are the occasional patients who use their stimulation only intermittently, often having effective long term pain relief while using their systems for only a portion of each day. 273 273 274 274 = Section IV.4.5: References = 276 + 277 +(% class="FreeForm" style="margin-left: 0in; text-indent: -0.25in;" %) 278 +~/~/ 279 +(% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(26, 26, 26);" %) Ben-David B, Haller G, Taylor P: Anterior spinal fusion complicated by paraplegia. A case report of a false-negative somatosensory-evoked potential. Spine (Phila Pa 1976) 12:536-539, 1987. 280 + 281 + 282 +(% class="FreeForm" style="margin-left: 0in; text-indent: -0.25in;" %) 283 +(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) (% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(26, 26, 26);" %)Ben-David B, Taylor PD, Haller GS: Posterior spinal fusion complicated by posterior column injury. A case report of a false-negative wake-up test. Spine (Phila Pa 1976) 12:540-543, 1987.(%%) 284 +\\(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) (% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(26, 26, 26);" %)Wagner W, Peghini-Halbig L, Maurer JC, Perneczky A: Intraoperative SEP monitoring in neurosurgery around the brain stem and cervical spinal cord: differential recording of subcortical components. J Neurosurg 81:213-220, 1994. 285 +\\Ryu H, Uemura K. Origins of the short latency somatosensory evoked potentials in cat~-~-with special reference to the sensory relay nuclei. Exp Neurol. 1988 Nov;102(2):177-84.(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) 286 +\\(% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(26, 26, 26);" %)Dunne JW, Silbert PL, Wren M. A prospective study of acute radiculopathy after scoliosis surgery. Clin Exp Neurol. 1991;28:180-90. 287 +\\Meyer PR Jr, Cotler HB, Gireesan GT. Operative neurological complications resulting from thoracic and lumbar spine internal fixation.Clin Orthop Relat Res. 1988 Dec;(237):125-31. 288 +\\Toleikis JR, Carlvin AO, Shapiro DE, Schafer MF. The use of dermatomal evoked responses during surgical procedures that use intrapedicular fixation of the lumbosacral spine. Spine (Phila Pa 1976). 1993 Dec;18(16): 2401-7. 289 +\\Owen JH, Padberg AM, Spahr-Holland L, Bridwell KH, Keppler L, Steffee AD. Clinical correlation between degenerative spine disease and dermatomal somatosensory-evoked potentials in humans. Spine (Phila Pa 1976). 1991 Jun;16(6 Suppl):S201-5. 290 +\\Rodriquez AA, Kanis L, Rodriquez AA, Lane D. Somatosensory evoked potentials from dermatomal stimulation as an indicator of L5 and S1 radiculopathy. Arch Phys Med Rehabil. 1987 Jun;68(6):366-8. 291 +\\Bose B, Wierzbowski LR, Sestokas AK. Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar spine surgery. Spine (Phila Pa 1976). 2002 Jul 1;27(13):1444-50. 292 + 293 + 294 +(% class="FreeForm" style="margin-left: 0in; text-indent: -0.25in;" %) 295 +(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) (% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(26, 26, 26);" %) Weiss DS. Spinal cord and nerve root monitoring during surgical treatment of lumbar stenosis. Clin Orthop Relat Res. 2001 Mar;(384):82-100. Review. 296 + 297 + 298 +(% class="FreeForm" style="margin-left: 0in; text-indent: -0.25in;" %) 299 +(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) (% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(26, 26, 26);" %) Holland NR, Kostuik JP. Continuous electromyographic monitoring to detect nerve root injury during thoracolumbar scoliosis surgery. 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Spinal cord stimulation versus reoperation for failed back surgery syndrome: a cost effectiveness and cost utility analysis based on a randomized, controlled trial.(% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(36, 39, 199);" %) (% style="font-family: ~"Times New Roman~",~"serif~";" %)Neurosurgery. 2007 Aug;61(2):361-8; discussion 368-9. Erratum in: Neurosurgery. 2009 Apr;64(4):601. 359 + 360 + 361 +(% class="FreeForm" style="margin: 0in 0in 2pt; text-indent: -0.25in;" %) 362 +(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) (% style="font-family: ~"Times New Roman~",~"serif~";" %)Taylor RJ, Taylor RS. 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Sites of action of subarachnoid lidocaine and tetracaine: observations with evoked potential monitoring during spinal cord stimulator implantation.(% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(182, 58, 23);" %) (% style="font-family: ~"Times New Roman~",~"serif~";" %)Reg Anesth. 1992 Jan-Feb;17(1):37-42. 399 + 400 + 401 +(% class="FreeForm" style="margin: 0in 0in 2pt; text-indent: -0.25in;" %) 402 +(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) (% style="font-family: ~"Times New Roman~",~"serif~";" %)Lang E, Krainick JU, Gerbershagen HU. Spinal cord transmission of impulses during high spinal anesthesia as measured by cortical evoked potentials.(% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(36, 39, 199);" %) (% style="font-family: ~"Times New Roman~",~"serif~";" %)Anesth Analg. 1989 Jul;69(1):15-20. 403 + 404 + 405 +(% class="FreeForm" style="margin: 0in 0in 2pt; text-indent: -0.25in;" %) 406 +(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) (% style="font-family: ~"Times New Roman~",~"serif~";" %)Holsheimer J, Barolat G, Struijk JJ, He J. Significance of the spinal cord position in spinal cord stimulation.(% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(36, 39, 199);" %) (% style="font-family: ~"Times New Roman~",~"serif~";" %)Acta Neurochir Suppl. 1995;64:119-24. 407 + 408 + 409 +(% class="FreeForm" style="margin: 0in 0in 2pt; text-indent: -0.25in;" %) 410 +(% style="font-family: ~"Times New Roman~"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;" %) (% style="font-family: ~"Times New Roman~",~"serif~";" %)Holsheimer J, den Boer JA, Struijk JJ, Rozeboom AR(% style="font-family: ~"Times New Roman~",~"serif~"; color: rgb(34, 34, 204);" %)__.__(% style="font-family: ~"Times New Roman~",~"serif~";" %) MR assessment of the normal position of the spinal cord in the spinal canal. AJNR Am J Neuroradiol. 1994 May;15(5):951-9. 411 + 412 +(% style="font-size: 12pt; font-family: ~"Times New Roman~",~"serif~";" %)Washburn S, Monroe CD, Cameron T. A Review of Articles Published on Spinal Cord Stimulation Treatment for Chronic Pain: 1981 - 2008.(% style="font-size: 16pt; font-family: ~"Times~",~"serif~";" %) (% style="font-size: 12pt; font-family: ~"Times New Roman~",~"serif~";" %)NANS meeting, Las Vegas, December 4-7, 2008.