Corrective Spine Surgery
One of the most common surgeries that a surgical neurophysiologist will encounter is corrective spine surgery.
What levels are we doing? The answer will let you know what muscle groups will be most affected and what you should monitor for EMG and Somatosensory. Is it Anterior or posterior? this will prompt you to ask for pre rotation baselines and give a queue to anesthesia that paralytic or gas could be a danger. Is the patient myelopatic? Are the arms going to be tucked or superman? do i need to worry about having 2.5 meter cables or brachial plexus monitoring? Bite blocks and how to place them, proper way to monitor the spine is with EMG, SSEP, tcMEP, EEG and be ready for eSTIM at all times. Plus coordinate your event log. What protocol will I use? Are we doing one level or two or three levels? What kind of instrumentation are we using? What is the primary concern for the patient? What is the primary concern for anesthesia? Should I separate out the biceps and triceps? Should I monitor the entire arm? Should I separate out the Thenar and Hypothenar? Is my protocol ready? DId I ask for a bite block?
Did you count the electrodes with the nurse? Do they need to stimulate? where am I going to place my ground? Where should I run by cables? What are the most relevant anatomical risks of this surgery? How can I help you?
What entails the surgery? establishing right from left and making sure that you are monitoring things correctly to be able to make sure and give the surgeon confident information? When is EMG significant? How much anesthesia is on board? What did the baseline look like? Can I check to make sure that nothing has changed? What are the latencies and amplitudes of my SEPs? What levels did I receive MEP responses from? Have they improved? What is the blood pressure?
What are the critical moments? When can I run a motor? Can i check a motor to make sure there are no changes? What if I observe a change? What kind of EMG activity am I seeing, is it sustained, is it high amplitude? can i run a motor to make sure there is no correlation? What are you going to do next? Can I establish a final before you change anesthesia?
Basically a couple of kinds, foraminotomies, acdf, psf, scoliosis, etcetera, Semper Panzaratus!
What levels are we doing? The answer will let you know what muscle groups will be most affected and what you should monitor for EMG and Somatosensory. Is it Anterior or posterior? this will prompt you to ask for pre rotation baselines and give a queue to anesthesia that paralytic or gas could be a danger. Is the patient myelopatic? Are the arms going to be tucked or superman? do i need to worry about having 2.5 meter cables or brachial plexus monitoring? Bite blocks and how to place them, proper way to monitor the spine is with EMG, SSEP, tcMEP, EEG and be ready for eSTIM at all times. Plus coordinate your event log. What protocol will I use? Are we doing one level or two or three levels? What kind of instrumentation are we using? What is the primary concern for the patient? What is the primary concern for anesthesia? Should I separate out the biceps and triceps? Should I monitor the entire arm? Should I separate out the Thenar and Hypothenar? Is my protocol ready? DId I ask for a bite block?
Did you count the electrodes with the nurse? Do they need to stimulate? where am I going to place my ground? Where should I run by cables? What are the most relevant anatomical risks of this surgery? How can I help you?
What entails the surgery? establishing right from left and making sure that you are monitoring things correctly to be able to make sure and give the surgeon confident information? When is EMG significant? How much anesthesia is on board? What did the baseline look like? Can I check to make sure that nothing has changed? What are the latencies and amplitudes of my SEPs? What levels did I receive MEP responses from? Have they improved? What is the blood pressure?
What are the critical moments? When can I run a motor? Can i check a motor to make sure there are no changes? What if I observe a change? What kind of EMG activity am I seeing, is it sustained, is it high amplitude? can i run a motor to make sure there is no correlation? What are you going to do next? Can I establish a final before you change anesthesia?
Basically a couple of kinds, foraminotomies, acdf, psf, scoliosis, etcetera, Semper Panzaratus!
Types of Cervical Cases
ACDF
Corpectomy
Posterior Spinal Fusion
Tumor
Corpectomy
Posterior Spinal Fusion
Tumor
Types of Thoracic Cases
Posterior Spinal Fusion
TLIF
Tumor
TLIF
Tumor
Types of Lumbar Cases
Posterior Spinal Fusion
TLIF
XLIF
Tumor
TLIF
XLIF
Tumor
Types of Sacral Cases
Posterior Spinal Fusion
XLIF
Tumor
XLIF
Tumor
Methods
A combination of EMG, tcMEP, SEP, EEG, T04 and eSTIM should cover just about any case