Neurophysiological assessment of the injured spinal cord: an intraoperative approach
Study design: Prospective, observational study. Objectives: To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatos...
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| Veröffentlicht in: | Spinal cord 2014-10, Vol.52 (10), p.749-757 |
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| creator | Costa, P Faccani, G Sala, F Montalenti, E Giobbe, M L Deletis, V |
| description | Study design:
Prospective, observational study.
Objectives:
To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI).
Setting:
Regional Trauma Center, Torino, Italy.
Methods:
Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI—6 of them with central cord syndrome and 1 with central cord plus Brown Sequard syndrome—and 20 patients were neurologically uncompromised.
Results:
The neurophysiologic profile of the complete SCI was the absence of both m-MEPs and e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs cranially to the lesion site. None of these patients recovered motor function in the follow-up. A clearly detectable caudal D wave was associated with motor recovery even in deeply paraparetic patients. In one neurologically incomplete patient a reversible deterioration of m-MEPs and e-MEPs was observed during the compression-distraction manoeuvre.
Conclusion:
Intraoperative neurophysiological evaluation of SCI patients can provide information about spinal cord function that is not retrievable by other clinical means and can correctly predict neurological outcome. Intraoperative testing during early stabilization of the spine of deeply paraparetic SCI patients provides additional information about their neurological profile. |
| doi_str_mv | 10.1038/sc.2014.138 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1622600051</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1622600051</sourcerecordid><originalsourceid>FETCH-LOGICAL-c564t-a5c00c05d656ce44031d25cc62fbca40dbe4c0625009016dd666cdbefd3a91603</originalsourceid><addsrcrecordid>eNqFkUtLAzEUhYMovlfuZcCNoFPzvLbuRHxB0U1dD2mSsVOmkzF3Rui_95aqiAiuEm4-zrknh7EjwQeCq-EFuoHkQg-EGm6wXaEvITcg9SbdFchcq5HaYXuIc875SIyG22xHGqEMN7DLJk-hT7GdLbGKdXytnK0zixgQF6Hpslhm3SxkVTPvU_AZtlVDgIvJX2W2oXmXbGxDsl31HjLbtilaNztgW6WtMRx-nvvs5e52cvOQj5_vH2-ux7kzoLvcGse548aDARe05kp4aZwDWU6d1dxPg3YcpKG9uQDvAcDRsPTKjgRwtc9O17pk-9YH7IpFhS7UtW1C7LEQICVQakr7L2qGIMhESUJPfqHz2CfKvaLgUmj6aEPU2ZpyKSKmUBZtqhY2LQvBi1UvBbpi1UtBONHHn5r9dBH8N_tVBAHnawDpqXkN6YfpH3ofD8KWXg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1567141385</pqid></control><display><type>article</type><title>Neurophysiological assessment of the injured spinal cord: an intraoperative approach</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Costa, P ; Faccani, G ; Sala, F ; Montalenti, E ; Giobbe, M L ; Deletis, V</creator><creatorcontrib>Costa, P ; Faccani, G ; Sala, F ; Montalenti, E ; Giobbe, M L ; Deletis, V</creatorcontrib><description>Study design:
Prospective, observational study.
Objectives:
To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI).
Setting:
Regional Trauma Center, Torino, Italy.
Methods:
Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI—6 of them with central cord syndrome and 1 with central cord plus Brown Sequard syndrome—and 20 patients were neurologically uncompromised.
Results:
The neurophysiologic profile of the complete SCI was the absence of both m-MEPs and e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs cranially to the lesion site. None of these patients recovered motor function in the follow-up. A clearly detectable caudal D wave was associated with motor recovery even in deeply paraparetic patients. In one neurologically incomplete patient a reversible deterioration of m-MEPs and e-MEPs was observed during the compression-distraction manoeuvre.
Conclusion:
Intraoperative neurophysiological evaluation of SCI patients can provide information about spinal cord function that is not retrievable by other clinical means and can correctly predict neurological outcome. Intraoperative testing during early stabilization of the spine of deeply paraparetic SCI patients provides additional information about their neurological profile.</description><identifier>ISSN: 1362-4393</identifier><identifier>EISSN: 1476-5624</identifier><identifier>DOI: 10.1038/sc.2014.138</identifier><identifier>PMID: 25135056</identifier><identifier>CODEN: SPCOFM</identifier><language>eng</language><publisher>London: Nature Publishing Group UK</publisher><subject>692/699/375 ; Adult ; Aged ; Anatomy ; Biomedical and Life Sciences ; Biomedicine ; Evoked Potentials, Motor ; Evoked Potentials, Somatosensory ; Female ; Follow-Up Studies ; Human Physiology ; Humans ; Italy ; Male ; Middle Aged ; Monitoring, Intraoperative - methods ; Neurochemistry ; Neuropsychology ; Neurosciences ; original-article ; Prospective Studies ; Recovery of Function ; Spinal Cord - physiopathology ; Spinal Cord - surgery ; Spinal Cord Injuries - physiopathology ; Spinal Cord Injuries - surgery ; Treatment Outcome ; Young Adult</subject><ispartof>Spinal cord, 2014-10, Vol.52 (10), p.749-757</ispartof><rights>International Spinal Cord Society 2014</rights><rights>Copyright Nature Publishing Group Oct 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c564t-a5c00c05d656ce44031d25cc62fbca40dbe4c0625009016dd666cdbefd3a91603</citedby><cites>FETCH-LOGICAL-c564t-a5c00c05d656ce44031d25cc62fbca40dbe4c0625009016dd666cdbefd3a91603</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/sc.2014.138$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/sc.2014.138$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25135056$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Costa, P</creatorcontrib><creatorcontrib>Faccani, G</creatorcontrib><creatorcontrib>Sala, F</creatorcontrib><creatorcontrib>Montalenti, E</creatorcontrib><creatorcontrib>Giobbe, M L</creatorcontrib><creatorcontrib>Deletis, V</creatorcontrib><title>Neurophysiological assessment of the injured spinal cord: an intraoperative approach</title><title>Spinal cord</title><addtitle>Spinal Cord</addtitle><addtitle>Spinal Cord</addtitle><description>Study design:
Prospective, observational study.
Objectives:
To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI).
Setting:
Regional Trauma Center, Torino, Italy.
Methods:
Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI—6 of them with central cord syndrome and 1 with central cord plus Brown Sequard syndrome—and 20 patients were neurologically uncompromised.
Results:
The neurophysiologic profile of the complete SCI was the absence of both m-MEPs and e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs cranially to the lesion site. None of these patients recovered motor function in the follow-up. A clearly detectable caudal D wave was associated with motor recovery even in deeply paraparetic patients. In one neurologically incomplete patient a reversible deterioration of m-MEPs and e-MEPs was observed during the compression-distraction manoeuvre.
Conclusion:
Intraoperative neurophysiological evaluation of SCI patients can provide information about spinal cord function that is not retrievable by other clinical means and can correctly predict neurological outcome. Intraoperative testing during early stabilization of the spine of deeply paraparetic SCI patients provides additional information about their neurological profile.</description><subject>692/699/375</subject><subject>Adult</subject><subject>Aged</subject><subject>Anatomy</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Evoked Potentials, Motor</subject><subject>Evoked Potentials, Somatosensory</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Human Physiology</subject><subject>Humans</subject><subject>Italy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Monitoring, Intraoperative - methods</subject><subject>Neurochemistry</subject><subject>Neuropsychology</subject><subject>Neurosciences</subject><subject>original-article</subject><subject>Prospective Studies</subject><subject>Recovery of Function</subject><subject>Spinal Cord - physiopathology</subject><subject>Spinal Cord - surgery</subject><subject>Spinal Cord Injuries - physiopathology</subject><subject>Spinal Cord Injuries - surgery</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1362-4393</issn><issn>1476-5624</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkUtLAzEUhYMovlfuZcCNoFPzvLbuRHxB0U1dD2mSsVOmkzF3Rui_95aqiAiuEm4-zrknh7EjwQeCq-EFuoHkQg-EGm6wXaEvITcg9SbdFchcq5HaYXuIc875SIyG22xHGqEMN7DLJk-hT7GdLbGKdXytnK0zixgQF6Hpslhm3SxkVTPvU_AZtlVDgIvJX2W2oXmXbGxDsl31HjLbtilaNztgW6WtMRx-nvvs5e52cvOQj5_vH2-ux7kzoLvcGse548aDARe05kp4aZwDWU6d1dxPg3YcpKG9uQDvAcDRsPTKjgRwtc9O17pk-9YH7IpFhS7UtW1C7LEQICVQakr7L2qGIMhESUJPfqHz2CfKvaLgUmj6aEPU2ZpyKSKmUBZtqhY2LQvBi1UvBbpi1UtBONHHn5r9dBH8N_tVBAHnawDpqXkN6YfpH3ofD8KWXg</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Costa, P</creator><creator>Faccani, G</creator><creator>Sala, F</creator><creator>Montalenti, E</creator><creator>Giobbe, M L</creator><creator>Deletis, V</creator><general>Nature Publishing Group UK</general><general>Nature Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7T7</scope><scope>7TK</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PJZUB</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQGLB</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20141001</creationdate><title>Neurophysiological assessment of the injured spinal cord: an intraoperative approach</title><author>Costa, P ; Faccani, G ; Sala, F ; Montalenti, E ; Giobbe, M L ; Deletis, V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c564t-a5c00c05d656ce44031d25cc62fbca40dbe4c0625009016dd666cdbefd3a91603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>692/699/375</topic><topic>Adult</topic><topic>Aged</topic><topic>Anatomy</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Evoked Potentials, Motor</topic><topic>Evoked Potentials, Somatosensory</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Human Physiology</topic><topic>Humans</topic><topic>Italy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Neurochemistry</topic><topic>Neuropsychology</topic><topic>Neurosciences</topic><topic>original-article</topic><topic>Prospective Studies</topic><topic>Recovery of Function</topic><topic>Spinal Cord - physiopathology</topic><topic>Spinal Cord - surgery</topic><topic>Spinal Cord Injuries - physiopathology</topic><topic>Spinal Cord Injuries - surgery</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Costa, P</creatorcontrib><creatorcontrib>Faccani, G</creatorcontrib><creatorcontrib>Sala, F</creatorcontrib><creatorcontrib>Montalenti, E</creatorcontrib><creatorcontrib>Giobbe, M L</creatorcontrib><creatorcontrib>Deletis, V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest Health & Medical Research Collection</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Applied & Life Sciences</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Spinal cord</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Costa, P</au><au>Faccani, G</au><au>Sala, F</au><au>Montalenti, E</au><au>Giobbe, M L</au><au>Deletis, V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Neurophysiological assessment of the injured spinal cord: an intraoperative approach</atitle><jtitle>Spinal cord</jtitle><stitle>Spinal Cord</stitle><addtitle>Spinal Cord</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>52</volume><issue>10</issue><spage>749</spage><epage>757</epage><pages>749-757</pages><issn>1362-4393</issn><eissn>1476-5624</eissn><coden>SPCOFM</coden><abstract>Study design:
Prospective, observational study.
Objectives:
To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI).
Setting:
Regional Trauma Center, Torino, Italy.
Methods:
Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI—6 of them with central cord syndrome and 1 with central cord plus Brown Sequard syndrome—and 20 patients were neurologically uncompromised.
Results:
The neurophysiologic profile of the complete SCI was the absence of both m-MEPs and e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs cranially to the lesion site. None of these patients recovered motor function in the follow-up. A clearly detectable caudal D wave was associated with motor recovery even in deeply paraparetic patients. In one neurologically incomplete patient a reversible deterioration of m-MEPs and e-MEPs was observed during the compression-distraction manoeuvre.
Conclusion:
Intraoperative neurophysiological evaluation of SCI patients can provide information about spinal cord function that is not retrievable by other clinical means and can correctly predict neurological outcome. Intraoperative testing during early stabilization of the spine of deeply paraparetic SCI patients provides additional information about their neurological profile.</abstract><cop>London</cop><pub>Nature Publishing Group UK</pub><pmid>25135056</pmid><doi>10.1038/sc.2014.138</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | 692/699/375 Adult Aged Anatomy Biomedical and Life Sciences Biomedicine Evoked Potentials, Motor Evoked Potentials, Somatosensory Female Follow-Up Studies Human Physiology Humans Italy Male Middle Aged Monitoring, Intraoperative - methods Neurochemistry Neuropsychology Neurosciences original-article Prospective Studies Recovery of Function Spinal Cord - physiopathology Spinal Cord - surgery Spinal Cord Injuries - physiopathology Spinal Cord Injuries - surgery Treatment Outcome Young Adult |
| title | Neurophysiological assessment of the injured spinal cord: an intraoperative approach |
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