Correlating Evoked Electromyography and Anatomic Factors During Spinal Cord Stimulation Implantation With Short-Term Outcomes.

Introduction: We examine ways intraoperative neuromonitoring during spinal cord stimulation (SCS) varies between a high-resolution investigational SCS (HR-SCS) paddle and a commercial paddle. Furthermore, the presence of evoked motor responses (eg, electromyography [EMG]) in painful regions during surgery is correlated to outcomes.

Materials And Methods: We used HR-SCS to assess EMG response from 18 patients (NCT05459324).

Cervicothoracic ventral-dorsal rhizotomy for treatment of brachial hypertonia in cerebral palsy.

Purpose: Cervicothoracic ventral-dorsal rhizotomy (VDR) is a potential treatment of medically refractory hypertonia in patients who are not candidates for intrathecal baclofen, particularly in cases of severe upper limb hypertonia with limited to no function. A longitudinal cohort was identified to highlight our institutional safety and efficacy using cervicothoracic VDR for the treatment of hypertonia.

Methods: Retrospective data analysis was performed for patients that underwent non-selective cervicothoracic VDR between 2022 and 2023.

Effects of Anesthetic Choice on the Incidence of Transcranial-Motor Potential-Induced Oral Trauma.

Transcranial motor-evoked potentials (TcMEPs) play an integral role in assessing motor tract function in surgical procedures where motor function is at risk. However, transcranial stimulation creates a risk for oral trauma. Several studies have reported on distinct factors that can influence the rate of TcMEP-induced oral trauma, but little is known about how an anesthetic regimen can influence this rate.

Diagnostic accuracy of intraoperative neuromonitoring in transcarotid artery revascularization.

Background: In recent years, transcarotid artery revascularization (TCAR) has emerged as a safe and effective alternative to carotid artery stenting. While intraoperative neuromonitoring (IONM) techniques such as electroencephalogram (EEG) and somatosensory evoked potentials (SSEPs) are often employed during TCAR, there is limited research on their diagnostic accuracy.

Methods: The authors retrospectively reviewed a multi-institutional IONM database of TCAR procedures performed with EEG and SSEP monitoring.

Improved Selectivity in Eliciting Evoked Electromyography Responses With High-Resolution Spinal Cord Stimulation.

Background And Objectives: As spinal cord stimulation (SCS) offers a therapy for increasing numbers of patients with chronic pain and spinal cord injury, it becomes increasingly important to better understand its somatotopy. In this prospective study, we investigate whether high-resolution SCS (HR-SCS) offers improved selectivity assessed through elicitation of evoked electromyography (EMG) responses as compared with commercial paddle leads.

Methods: Vertical tripole configurations were used to elicit EMG responses in both types of paddles placed for standard-of-care indications between T6 and T10.

Navigated Radiofrequency Ablation Peripheral Rhizotomy for Lumbosacral Hypertonia in a Nonambulatory Patient With Spinal Fusion: Indications, Surgical Techniques, and Lessons Learned.

Background And Objectives: Radiofrequency ablation (RFA) is a destructive therapy which causes target tissue destruction by application of a thermal dose. Neurosurgical applications of RFA are well-described for myriad chronic pain and movement disorder diagnoses. In fact, RFA pallidotomy and thalamotomy are the initial procedures from which the field of neurosurgical management for movement disorders emerged.

Investigation of the intraoperative cortical responses to spinal motor mapping in a patient with chronic pain.

Intraoperative neurophysiological monitoring (IONM) in spinal cord stimulation (SCS) surgery for chronic pain is shown to provide effective guidance during device placement. Electromyography (EMG) is used to determine the laterality of the paddle. In some SCS cases, laterality cannot be obtained via EMG due to patient physiology.

High-Resolution Spinal Motor Mapping Using Thoracic Spinal Cord Stimulation in Patients With Chronic Pain.

Background: High-resolution spinal cord stimulation (HR-SCS) paddle can stimulate medial-dorsal columns and extend stimulation coverage to the laterally positioned spinal targets.

Objective: To investigate the medio-lateral selectivity of an HR-SCS paddle in patients with chronic pain.

Methods: During standard-of-care spinal cord stimulation (SCS) placement, epidurally evoked electromyography and antidromic dorsal column-evoked potentials were recorded in 12 subjects using an HR-SCS paddle with 8 medio-lateral sites spanning the full epidural width at thoracic T9-12 and a commercial paddle consecutively.

Effects of anode position on pedicle screw testing during lumbosacral spinal fusion surgery.

Of Background Data: Pedicle screws are commonly placed with lumbar/lumbosacral fusions. Triggered electromyography (tEMG), which employs the application of electrical current between the screw and a complementary anode to determine thresholds of conduction, may be utilized to confirm the safe placement of such implants. While previous research has established clinical thresholds associated with safe screw placement, there is variability in clinical practice of anode placement which could lead to unreliable measurements.

Differences in EEG patterns between tonic and high frequency spinal cord stimulation in chronic pain patients.

Objective: To investigate the differences in neural patterns between spinal cord stimulation (SCS) waveforms (60-Hz tonic vs 10-KHz high frequency stimulation, HFS) and their correlation to stimulation-induced pain relief.

Methods: We recorded 10-channel electroencephalogram (EEG) in response to stimulation ON and OFF in 9 chronic pain patients (4 women, 5 men) during SCS surgery and examined the intraoperative spatio-spectral EEG features.

Results: We discovered stronger relative alpha power in the somatosensory region and higher trend in alpha/theta peak power ratio in frontal cortex with HFS.

Percutaneous Threshold of Facial Nerve Stimulation Predicts Facial Canal Dehiscence.

Iatrogenic facial nerve (FN) injury is one of the most feared complications of otologic surgery. Dehiscence of the bony covering of the FN within the temporal bone increases FN vulnerability to accidental injury. High-resolution computed tomography (HRCT) of the temporal bone is used preoperatively to assess middle ear and mastoid anatomy; however, it is unreliable for detecting facial canal dehiscence.

Intraoperative Neuromonitoring Alarms: Relationship of the Surgeon's Decision to Intervene (or Not) and Clinical Outcomes in a Subset of Spinal Surgical Patients with a New Postoperative Neurological Deficit.

Background: The goal of intraoperative neurophysiologic monitoring (IONM) is to minimize neurologic injury during surgery, yet patients still emerge with postoperative deficits. Few studies focus on outcomes relative to IONM alarms and interventions in this population. The authors sought to analyze the influence of IONM alarms with and without surgical intervention on patient outcome in spinal surgical patients who suffered immediate postoperative neurologic deficits.

Perils of intraoperative neurophysiological monitoring: analysis of "false-negative" results in spine surgeries.

Background Context: Although some authors have published case reports describing false negatives in intraoperative neurophysiological monitoring (IONM), a systematic review of causes of false-negative IONM results is lacking.

Purpose: The objective of this study was to analyze false-negative IONM findings in spine surgery.

Study Design: This is a retrospective cohort analysis.

Transcranial Motor Evoked Potential Alarm Criteria to Predict Foot Drop Injury During Lumbosacral Surgery.

Study Design: A retrospective cohort analysis.

Objective: This study aims to investigate whether waveform alterations in transcranial motor evoked potentials (TCMEPs) can reliably predict postoperative foot drop.

Summary Of Background Data: Nerve injury leading to foot drop is a potential complication of lumbosacral surgery.