Evoked Potential

Anterior Cervical Discectomy & Fusion/ACDF

PROCEDURE

Removal of intervertebral disc with a replacement interbody that is typically secured into position with a plate.

ELECTRODES

Corkscrews - 10: Fz, Cz, CP3, CP4, CS5, M1, M2, M3, M4, GND
Needles - 20 (40);Trapezius, Deltoid, Biceps, Triceps, Brachioradialis, Thenar/Hypothenar, Tibialis Anterior/Gastrocnemius, Extensor Hallucis/Abductor Hallucis, ULN x 2, PTN x 2, GND

MODALITIES

EMG - All muscle groups
tEMG - Cervical muscle groups
SEP - UlN, PTN, cortical and subcortical
MEP - Responses from all muscle groups listed
EEG - 2 Channels: Fpz - CP3, FPz - CP4
T04 - For anesthetic depth of muscle relaxant

​NOTES:
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Additional electrodes can be placed at Erb's point for accuracy of stimulus delivery for SEPs, Xiphoid for extra cervical coverage of vagus nerve innervation. Establish baseline SEPs, MEPs, and EEG prior to incision with continuous monitoring until fascia is closed. The critical moments are the removal of disc when the posterior longitudinal ligament is observed and insertion and securing of the interbody.
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