Journal of spinal disorders & techniques · 2007
Using intraoperative electrophysiologic monitoring as a diagnostic tool for determining levels to decompress in the cervical spine: a case report.
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Chappuis James L, Johnson Gregory
Аннотация
OBJECTIVE: This report describes the clinical usefulness of using intraoperative electrophysiologic monitoring as a diagnostic tool for determining levels to decompress in the cervical spine.
METHODS: A 59-year-old man was experiencing intractable neck and left upper extremity pain after sustaining a second spinal injury. (The patient had previously undergone an anterior cervical discectomy and fusion at C5-C6 with plating to treat injuries from a motor vehicle accident.) On examination, he had no motor changes but did have pain in his left upper extremity and numbness of the left thumb and index finger. A myelogram and postmyelogram computed tomography scan revealed a disc herniation at C4-C5 with severe neural foraminal disease on the left side of C4-C5 and residual posterior osteophytes with questionable neuroforaminal stenosis on the left side of C5-C6. Routine electrophysiologic studies showed mild irritation of the left biceps (left C5-C6 nerve root), indicating radiculopathy. The patient was admitted with plans to undergo plate removal, exploration of the fusion at C5-C6, and an anterior cervical discectomy with foraminotomies and fusion at C4-C5. Continuous free-running electromyography was recorded during the surgical procedures.
RESULTS: The surgery was performed as planned; however, the irritation observed at C5-C6 did not subside. Relying on this information, as an extension of the patient's history and physical examination, a decision was made to remove the previous fusion at C5-C6 and to explore the left C6 root. A very tight neural foramen was found at this level. After decompression and foraminotomy, no electrophysiologic activity above baseline was recorded at C5-C6. The patient was then fused and plated from C4 to C6, and awoke with no left upper extremity pain. Neurologic examination was normal immediately after surgery and at 3 months follow-up.
CONCLUSIONS: Intraoperative, continuous free-running electromyography proved clinically effective in determining the course of surgery.
METHODS: A 59-year-old man was experiencing intractable neck and left upper extremity pain after sustaining a second spinal injury. (The patient had previously undergone an anterior cervical discectomy and fusion at C5-C6 with plating to treat injuries from a motor vehicle accident.) On examination, he had no motor changes but did have pain in his left upper extremity and numbness of the left thumb and index finger. A myelogram and postmyelogram computed tomography scan revealed a disc herniation at C4-C5 with severe neural foraminal disease on the left side of C4-C5 and residual posterior osteophytes with questionable neuroforaminal stenosis on the left side of C5-C6. Routine electrophysiologic studies showed mild irritation of the left biceps (left C5-C6 nerve root), indicating radiculopathy. The patient was admitted with plans to undergo plate removal, exploration of the fusion at C5-C6, and an anterior cervical discectomy with foraminotomies and fusion at C4-C5. Continuous free-running electromyography was recorded during the surgical procedures.
RESULTS: The surgery was performed as planned; however, the irritation observed at C5-C6 did not subside. Relying on this information, as an extension of the patient's history and physical examination, a decision was made to remove the previous fusion at C5-C6 and to explore the left C6 root. A very tight neural foramen was found at this level. After decompression and foraminotomy, no electrophysiologic activity above baseline was recorded at C5-C6. The patient was then fused and plated from C4 to C6, and awoke with no left upper extremity pain. Neurologic examination was normal immediately after surgery and at 3 months follow-up.
CONCLUSIONS: Intraoperative, continuous free-running electromyography proved clinically effective in determining the course of surgery.
Предметные рубрики MeSH
Cervical VertebraeDecompression, SurgicalElectrodiagnosisElectromyographyElectrophysiologyHumansInternal FixatorsIntervertebral Disc DisplacementMaleMiddle AgedMonitoring, IntraoperativeMuscle, SkeletalNeck PainNeural ConductionPredictive Value of TestsRadiculopathyReoperationSpinal FusionSpinal InjuriesSpinal NervesSpinal StenosisTomography, X-Ray ComputedTreatment Outcome