The document discusses neuromonitoring studies during spine surgery. It begins by asking who, what, when, where, why and how regarding neuromonitoring. It then defines iatrogenic injury and discusses how it can occur during spine surgery. The document notes incidence rates of iatrogenic injury in different spine surgeries without neuromonitoring. It discusses why avoiding iatrogenic injury is important to maintain quality of life and reduce costs. It then discusses how intraoperative neuromonitoring can help detect changes in neurologic status through functional assessment using techniques like somatosensory evoked potentials, motor evoked potentials and electromyography. The document reviews effectiveness data for these techniques in cervical
This presentation introduces medical professionals and allied healthcare associates to the fundamental rationale, objectives, techniques, and utilizations of intraoperative neurophysiologic monitoring (IONM).
This document discusses different methods of intraoperative neuromonitoring (IONM) during thyroid surgery to prevent injury to the recurrent laryngeal nerve (RLN). It describes standard intermittent IONM and introduces continuous IONM (C-IONM) using vagus nerve stimulation. C-IONM allows early detection of adverse electromyography changes before RLN injury occurs and enables surgeons to modify maneuvers to prevent injury. Studies show C-IONM may reduce postoperative RLN paralysis rates compared to intermittent monitoring and helps identify surgical steps that cause nerve degradation.
This document discusses diffuse axonal injury (DAI), a type of traumatic brain injury seen in fatal TBI cases. It provides a historical perspective on DAI and reviews the pathology, including microscopic findings. DAI involves damage to axons throughout the brain and is graded based on its severity and location. While commonly seen in fatal TBI, the pathology of mild DAI requires further study. The document also describes a unique brain tissue archive containing over 2,000 traumatic brain injury cases accrued over decades that has been used in over 150 publications to better understand DAI and its association with neurodegenerative conditions.
This document discusses traumatic brain injury (TBI) and the neurosurgical response at the Cushing Neuroscience Institute. It describes that TBI affects up to 2% of the population annually and requires specialized care. It outlines the process for evaluating and classifying TBI severity (mild, moderate, severe) upon patient arrival based on Glasgow Coma Scale. For moderate and severe TBI, surgical intervention may be needed and is determined by factors like brain swelling/bleeding seen on CT scan. The neurosurgery team is available 24/7 to treat TBI emergencies.
FRCS Revision - Brachial Plexus & HandsChye Yew Ng
This document discusses examination and treatment of brachial plexus injuries. It provides an overview of brachial plexus anatomy and classifications of injuries. Common clinical presentations are described including patterns associated with different levels and types of injuries. Timing of surgery is based on the severity and chronicity of the injury. Intraoperative assessment helps determine graftability and motor function to guide repair.
This presentation discusses current management of spinal cord injuries and includes the following: It defines spinal cord injuries and discusses epidemiology, types, and potential outcomes. It then covers causes, importance of awareness and immediate management, physiotherapy goals and techniques. New developments are also summarized, including electrical stimulation, restoring respiratory function, epidural stimulation, stem cells, brain-computer interfaces, and robotic assisted therapy.
This presentation introduces medical professionals and allied healthcare associates to the fundamental rationale, objectives, techniques, and utilizations of intraoperative neurophysiologic monitoring (IONM).
This document discusses different methods of intraoperative neuromonitoring (IONM) during thyroid surgery to prevent injury to the recurrent laryngeal nerve (RLN). It describes standard intermittent IONM and introduces continuous IONM (C-IONM) using vagus nerve stimulation. C-IONM allows early detection of adverse electromyography changes before RLN injury occurs and enables surgeons to modify maneuvers to prevent injury. Studies show C-IONM may reduce postoperative RLN paralysis rates compared to intermittent monitoring and helps identify surgical steps that cause nerve degradation.
This document discusses diffuse axonal injury (DAI), a type of traumatic brain injury seen in fatal TBI cases. It provides a historical perspective on DAI and reviews the pathology, including microscopic findings. DAI involves damage to axons throughout the brain and is graded based on its severity and location. While commonly seen in fatal TBI, the pathology of mild DAI requires further study. The document also describes a unique brain tissue archive containing over 2,000 traumatic brain injury cases accrued over decades that has been used in over 150 publications to better understand DAI and its association with neurodegenerative conditions.
This document discusses traumatic brain injury (TBI) and the neurosurgical response at the Cushing Neuroscience Institute. It describes that TBI affects up to 2% of the population annually and requires specialized care. It outlines the process for evaluating and classifying TBI severity (mild, moderate, severe) upon patient arrival based on Glasgow Coma Scale. For moderate and severe TBI, surgical intervention may be needed and is determined by factors like brain swelling/bleeding seen on CT scan. The neurosurgery team is available 24/7 to treat TBI emergencies.
FRCS Revision - Brachial Plexus & HandsChye Yew Ng
This document discusses examination and treatment of brachial plexus injuries. It provides an overview of brachial plexus anatomy and classifications of injuries. Common clinical presentations are described including patterns associated with different levels and types of injuries. Timing of surgery is based on the severity and chronicity of the injury. Intraoperative assessment helps determine graftability and motor function to guide repair.
This presentation discusses current management of spinal cord injuries and includes the following: It defines spinal cord injuries and discusses epidemiology, types, and potential outcomes. It then covers causes, importance of awareness and immediate management, physiotherapy goals and techniques. New developments are also summarized, including electrical stimulation, restoring respiratory function, epidural stimulation, stem cells, brain-computer interfaces, and robotic assisted therapy.
An isolated posterior dislocation of radial head in adults – A rare injury: A...Apollo Hospitals
An isolated posterior dislocation of radial head in adults is a rare injury. We report a 32-year-old male patient with posterior dislocation of radial head associated with articular fracture fragment of the radial head. Open reduction and internal fixation with a miniscrew was done and patient had excellent outcome at a follow up of 2 years.
This document discusses peripheral nerve injuries, including:
- Classification systems for nerve injuries including Seddon and Sunderland classifications.
- Causes of nerve injuries including trauma, radiation, and ischemia.
- Evaluation of patients including history, physical exam, and electrodiagnostic tests.
- Surgical principles for nerve repair including primary repair, nerve grafts, and nerve transfers.
- Post-operative management including splinting and physical therapy.
- Potential complications include failure of repair, neuromas, and infections.
Purtscher’s Retinopathy after Airbag Injury, Six month Progression and Sequel...CrimsonpublishersMSOR
Purtscher’s retinopathy is a microvasculopathy that has been
well documented but poorly understood. The earliest case was
reported by Otmar Purtscher in 1910, which described a man
who suffered cranial trauma after falling out of a tree. The current incidence of Purtscher’s retinopathy is estimated at 0.24 persons per million per year [1]. When identified, Purtscher’s is most commonly seen in young men in the setting of trauma [2]. Seat belt trauma associated with motor vehicle accidents leading to Purtscher’s retinopathy has been reported in several papers. However, only one previous case of Purtscher’s retinopathy associated with traumatic optic neuropathy has been attributed to airbag injury [3-7].
An isolated posterior dislocation of radial head in adults - A rare injury: A...Apollo Hospitals
An isolated posterior dislocation of radial head in adults is a rare injury. We report a 32-year-old male patient with posterior dislocation of radial head associated with articular fracture fragment of the radial head. Open reduction and internal fixation with a miniscrew was done and patient had excellent outcome at a follow up of 2 years.
This document discusses peripheral nerve injuries. It begins with an overview and classifications of nerve injuries including Seddon and Sunderland systems. Principles of nerve surgery such as neurolysis and nerve repair are covered. Factors that influence nerve regeneration like age, injury level and surgical delay are addressed. The document concludes with details on the peripheral nerve injury service contact information.
This document summarizes an investigation into sensors placed within an artificial spinal disk prosthesis to measure loading in vitro. Strain gauges and piezoresistive sensors were embedded in the disk's plates and inlay. The sensors showed linear responses to loads up to 4kN with good repeatability. Strain gauges proved more reliable than piezoresistive sensors. This work paves the way for detailed in vitro and in vivo loading studies using instrumented spinal implants.
Fishing in the Dark: Retrieving Broken Instruments during a Spinal Lumbar Dis...CrimsonPublishersOPROJ
Fishing in the Dark: Retrieving Broken Instruments during a Spinal Lumbar Discectomy by Dello Russo Bibiana* in Crimson Publishers: Orthopaedic research journals impact factor
The document discusses the history, pathophysiology, diagnosis, and treatment of traumatic axonal injury (TAI). TAI was first described in the mid-20th century and involves microscopic lesions in brain tissue resulting from mechanical impact. It involves both primary damage from the initial impact as well as secondary damage from chemical and metabolic changes. Diagnosis involves imaging like CT, MRI, and DTI to identify lesions in white matter tracts. Currently there is no specific treatment for TAI, but care focuses on stabilizing the patient and preventing increases in intracranial pressure to limit secondary damage.
1. The document discusses traumatic brain injury (TBI), noting that it causes 200,000 injuries and 12,000 deaths per year in France, disproportionately affecting those under 25.
2. Imaging is important after cranio-encephalic trauma to understand primary brain lesions, secondary complications, and post-traumatic vascular issues. Common primary injuries include skull fractures, epidural hematomas, subdural hematomas, cerebral contusions, and diffuse axonal injury.
3. Secondary complications include vascular injuries like dissections, venous thromboses, and carotid-cavernous fistulas. Infections, hydrocephalus, and herniations can also occur and are associated with unfavor
The document discusses long-latency motor evoked potentials (LLMEPs) observed in individuals with pre-existing spinal cord injuries undergoing spine surgery. LLMEPs were observed in 42% of cases and demonstrated variability in characteristics across different spinal cord injury etiologies, levels, severity, and durations. Six case studies are presented that illustrate the variability of LLMEP observations. While LLMEPs have been observed in other populations, their origin and prognostic significance in spinal cord injury remains unclear. Additional research is needed to understand LLMEPs in spinal cord injury and determine if they could serve as a prognostic indicator.
This document describes a study that designed an artificial spinal disk prosthesis implanted with sensors to measure in vivo loading on the spine. The disk was implanted with strain gauges and piezoresistive sensors and tested in vitro by applying loads up to 1kN with and without animal vertebrae. The results showed the sensor outputs had a reliable relationship with applied loads and provided promising data for developing an intelligent prosthesis that can noninvasively measure multi-directional in vivo spinal loading. Further animal and cadaver tests are still needed to optimize sensors and validate the approach.
The Neurometabolic Cascade of a ConcussionAmanda McClure
This document discusses concussions in athletes and the physiological effects of concussions. It begins by defining a concussion and outlining common concussion symptoms. It then discusses the neurometabolic cascade that occurs immediately after a concussion, including excess neurotransmitter release and energy crisis in the brain. This can lead to cell death and impairment of neuronal connectivity. The document also discusses the risk of further injury if an athlete returns to play before fully healing from an initial concussion, as well as physiological damage found through MRI studies, such as increased brain activation in concussed athletes during tasks.
The Important Nerves During Venous AblationVein Global
By: John Mauriello, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This document discusses non-invasive neural prostheses. It begins with an introduction defining prostheses and neural prostheses. It then provides a brief history of neural prostheses development. The document outlines the main types of neural prostheses - invasive and non-invasive. It focuses on non-invasive techniques like EEG and MEG. Advantages like being non-surgical and disadvantages like lower resolution are described. Applications in health and ethical considerations are also mentioned. The conclusion discusses the potential of neural prostheses to help paralyzed individuals.
The document discusses spinal injury and spine motion restriction. It provides information on the anatomy and physiology of the spine and spinal cord. It also outlines the assessment process for potential spinal injuries, including maintaining spine alignment during primary and secondary assessments, evaluating motor and sensory function, and applying a cervical collar when indicated. Special considerations like neurogenic shock are also addressed.
This document discusses implantable medical devices (IMDs). It provides examples of different types of IMDs including implantable cardiac pacemakers, defibrillators, cochlear implants, nerve stimulators, and infusion pumps. The document outlines the definition of a medical device and discusses applications of IMDs like heart failure, obesity, and diabetes treatment. It also describes recent advancements in prosthetic legs that use Bluetooth to regulate stride and pressure and robotic microprocessor knees that provide greater walking control.
This document provides information about magnetic resonance imaging (MRI). It begins with background on MRI, noting its wide range of medical applications and over 25,000 scanners in use worldwide. The document then covers MRI goals, definitions, functions, descriptions of how MRI works and the scanning process, precautions, preparations, benefits, disadvantages, risks, and parental concerns. Key points include that MRI uses magnetic fields and radio waves to generate detailed soft tissue images without radiation. Precautions are taken for metal objects and certain implants. MRI is generally safe but may cause claustrophobia or reactions to contrast agents in rare cases.
This document discusses mild traumatic brain injuries (concussions) in contact sports. It notes that while most concussions do not involve loss of consciousness, continuing to play after one makes a player more vulnerable to further injury. It then describes the cellular damage caused by concussions and cumulative effects on college athletes. Studies found retired NFL players were at higher risk of dementia and chronic traumatic encephalopathy. Supplementation with omega-3 fatty acids like DHA may help reduce damage and improve outcomes after brain injury in animal studies. Helmets may not fully prevent brain injuries from rotational forces. Strict concussion management is important to avoid early return to play.
Securing the Healthcare Industry : Implantable Medical DevicesTandhy Simanjuntak
This document discusses implantable medical devices (IMDs) such as pacemakers, insulin pumps, and neurostimulators. It outlines the types of IMDs commonly used in the US and provides examples. It then discusses the security risks and challenges associated with IMDs, including potential attacks such as reprogramming devices or depleting their resources. Criteria for improving IMD security and privacy are proposed.
This document provides information about stroke for nurses, including basic stroke facts, types of stroke, the effects of delayed treatment, and roles and responsibilities for managing stroke patients. It aims to describe stroke, improve staff performance in stroke care, and reduce time to treatment through interdepartmental teamwork in order to limit cell and nerve death caused by strokes. The primary goals are to describe stroke basics, types of stroke, how staff impact outcomes, and the nurse's role in patient management.
The document provides information about a staff training on stroke management at Good Samaritan Hospital, including:
1. The goals of the training are to describe basic stroke facts, types of stroke, how staff can impact outcomes, and the nurse's role in patient management.
2. Timely treatment is critical, as each minute of delay results in loss of brain cells and function. The training aims to optimize teamwork and processes to minimize time to treatment.
3. Strokes are either ischemic or hemorrhagic, and immediate assessment, labs, imaging, and potential thrombolysis are essential to determining treatment and eligibility for t-PA.
An isolated posterior dislocation of radial head in adults – A rare injury: A...Apollo Hospitals
An isolated posterior dislocation of radial head in adults is a rare injury. We report a 32-year-old male patient with posterior dislocation of radial head associated with articular fracture fragment of the radial head. Open reduction and internal fixation with a miniscrew was done and patient had excellent outcome at a follow up of 2 years.
This document discusses peripheral nerve injuries, including:
- Classification systems for nerve injuries including Seddon and Sunderland classifications.
- Causes of nerve injuries including trauma, radiation, and ischemia.
- Evaluation of patients including history, physical exam, and electrodiagnostic tests.
- Surgical principles for nerve repair including primary repair, nerve grafts, and nerve transfers.
- Post-operative management including splinting and physical therapy.
- Potential complications include failure of repair, neuromas, and infections.
Purtscher’s Retinopathy after Airbag Injury, Six month Progression and Sequel...CrimsonpublishersMSOR
Purtscher’s retinopathy is a microvasculopathy that has been
well documented but poorly understood. The earliest case was
reported by Otmar Purtscher in 1910, which described a man
who suffered cranial trauma after falling out of a tree. The current incidence of Purtscher’s retinopathy is estimated at 0.24 persons per million per year [1]. When identified, Purtscher’s is most commonly seen in young men in the setting of trauma [2]. Seat belt trauma associated with motor vehicle accidents leading to Purtscher’s retinopathy has been reported in several papers. However, only one previous case of Purtscher’s retinopathy associated with traumatic optic neuropathy has been attributed to airbag injury [3-7].
An isolated posterior dislocation of radial head in adults - A rare injury: A...Apollo Hospitals
An isolated posterior dislocation of radial head in adults is a rare injury. We report a 32-year-old male patient with posterior dislocation of radial head associated with articular fracture fragment of the radial head. Open reduction and internal fixation with a miniscrew was done and patient had excellent outcome at a follow up of 2 years.
This document discusses peripheral nerve injuries. It begins with an overview and classifications of nerve injuries including Seddon and Sunderland systems. Principles of nerve surgery such as neurolysis and nerve repair are covered. Factors that influence nerve regeneration like age, injury level and surgical delay are addressed. The document concludes with details on the peripheral nerve injury service contact information.
This document summarizes an investigation into sensors placed within an artificial spinal disk prosthesis to measure loading in vitro. Strain gauges and piezoresistive sensors were embedded in the disk's plates and inlay. The sensors showed linear responses to loads up to 4kN with good repeatability. Strain gauges proved more reliable than piezoresistive sensors. This work paves the way for detailed in vitro and in vivo loading studies using instrumented spinal implants.
Fishing in the Dark: Retrieving Broken Instruments during a Spinal Lumbar Dis...CrimsonPublishersOPROJ
Fishing in the Dark: Retrieving Broken Instruments during a Spinal Lumbar Discectomy by Dello Russo Bibiana* in Crimson Publishers: Orthopaedic research journals impact factor
The document discusses the history, pathophysiology, diagnosis, and treatment of traumatic axonal injury (TAI). TAI was first described in the mid-20th century and involves microscopic lesions in brain tissue resulting from mechanical impact. It involves both primary damage from the initial impact as well as secondary damage from chemical and metabolic changes. Diagnosis involves imaging like CT, MRI, and DTI to identify lesions in white matter tracts. Currently there is no specific treatment for TAI, but care focuses on stabilizing the patient and preventing increases in intracranial pressure to limit secondary damage.
1. The document discusses traumatic brain injury (TBI), noting that it causes 200,000 injuries and 12,000 deaths per year in France, disproportionately affecting those under 25.
2. Imaging is important after cranio-encephalic trauma to understand primary brain lesions, secondary complications, and post-traumatic vascular issues. Common primary injuries include skull fractures, epidural hematomas, subdural hematomas, cerebral contusions, and diffuse axonal injury.
3. Secondary complications include vascular injuries like dissections, venous thromboses, and carotid-cavernous fistulas. Infections, hydrocephalus, and herniations can also occur and are associated with unfavor
The document discusses long-latency motor evoked potentials (LLMEPs) observed in individuals with pre-existing spinal cord injuries undergoing spine surgery. LLMEPs were observed in 42% of cases and demonstrated variability in characteristics across different spinal cord injury etiologies, levels, severity, and durations. Six case studies are presented that illustrate the variability of LLMEP observations. While LLMEPs have been observed in other populations, their origin and prognostic significance in spinal cord injury remains unclear. Additional research is needed to understand LLMEPs in spinal cord injury and determine if they could serve as a prognostic indicator.
This document describes a study that designed an artificial spinal disk prosthesis implanted with sensors to measure in vivo loading on the spine. The disk was implanted with strain gauges and piezoresistive sensors and tested in vitro by applying loads up to 1kN with and without animal vertebrae. The results showed the sensor outputs had a reliable relationship with applied loads and provided promising data for developing an intelligent prosthesis that can noninvasively measure multi-directional in vivo spinal loading. Further animal and cadaver tests are still needed to optimize sensors and validate the approach.
The Neurometabolic Cascade of a ConcussionAmanda McClure
This document discusses concussions in athletes and the physiological effects of concussions. It begins by defining a concussion and outlining common concussion symptoms. It then discusses the neurometabolic cascade that occurs immediately after a concussion, including excess neurotransmitter release and energy crisis in the brain. This can lead to cell death and impairment of neuronal connectivity. The document also discusses the risk of further injury if an athlete returns to play before fully healing from an initial concussion, as well as physiological damage found through MRI studies, such as increased brain activation in concussed athletes during tasks.
The Important Nerves During Venous AblationVein Global
By: John Mauriello, M.D.
Visit VeinGlobal at http://www.veinglobal.com/ for more presentations and videos on this topic, or for more information on venous disease news, education and research.
This document discusses non-invasive neural prostheses. It begins with an introduction defining prostheses and neural prostheses. It then provides a brief history of neural prostheses development. The document outlines the main types of neural prostheses - invasive and non-invasive. It focuses on non-invasive techniques like EEG and MEG. Advantages like being non-surgical and disadvantages like lower resolution are described. Applications in health and ethical considerations are also mentioned. The conclusion discusses the potential of neural prostheses to help paralyzed individuals.
The document discusses spinal injury and spine motion restriction. It provides information on the anatomy and physiology of the spine and spinal cord. It also outlines the assessment process for potential spinal injuries, including maintaining spine alignment during primary and secondary assessments, evaluating motor and sensory function, and applying a cervical collar when indicated. Special considerations like neurogenic shock are also addressed.
This document discusses implantable medical devices (IMDs). It provides examples of different types of IMDs including implantable cardiac pacemakers, defibrillators, cochlear implants, nerve stimulators, and infusion pumps. The document outlines the definition of a medical device and discusses applications of IMDs like heart failure, obesity, and diabetes treatment. It also describes recent advancements in prosthetic legs that use Bluetooth to regulate stride and pressure and robotic microprocessor knees that provide greater walking control.
This document provides information about magnetic resonance imaging (MRI). It begins with background on MRI, noting its wide range of medical applications and over 25,000 scanners in use worldwide. The document then covers MRI goals, definitions, functions, descriptions of how MRI works and the scanning process, precautions, preparations, benefits, disadvantages, risks, and parental concerns. Key points include that MRI uses magnetic fields and radio waves to generate detailed soft tissue images without radiation. Precautions are taken for metal objects and certain implants. MRI is generally safe but may cause claustrophobia or reactions to contrast agents in rare cases.
This document discusses mild traumatic brain injuries (concussions) in contact sports. It notes that while most concussions do not involve loss of consciousness, continuing to play after one makes a player more vulnerable to further injury. It then describes the cellular damage caused by concussions and cumulative effects on college athletes. Studies found retired NFL players were at higher risk of dementia and chronic traumatic encephalopathy. Supplementation with omega-3 fatty acids like DHA may help reduce damage and improve outcomes after brain injury in animal studies. Helmets may not fully prevent brain injuries from rotational forces. Strict concussion management is important to avoid early return to play.
Securing the Healthcare Industry : Implantable Medical DevicesTandhy Simanjuntak
This document discusses implantable medical devices (IMDs) such as pacemakers, insulin pumps, and neurostimulators. It outlines the types of IMDs commonly used in the US and provides examples. It then discusses the security risks and challenges associated with IMDs, including potential attacks such as reprogramming devices or depleting their resources. Criteria for improving IMD security and privacy are proposed.
This document provides information about stroke for nurses, including basic stroke facts, types of stroke, the effects of delayed treatment, and roles and responsibilities for managing stroke patients. It aims to describe stroke, improve staff performance in stroke care, and reduce time to treatment through interdepartmental teamwork in order to limit cell and nerve death caused by strokes. The primary goals are to describe stroke basics, types of stroke, how staff impact outcomes, and the nurse's role in patient management.
The document provides information about a staff training on stroke management at Good Samaritan Hospital, including:
1. The goals of the training are to describe basic stroke facts, types of stroke, how staff can impact outcomes, and the nurse's role in patient management.
2. Timely treatment is critical, as each minute of delay results in loss of brain cells and function. The training aims to optimize teamwork and processes to minimize time to treatment.
3. Strokes are either ischemic or hemorrhagic, and immediate assessment, labs, imaging, and potential thrombolysis are essential to determining treatment and eligibility for t-PA.
The document summarizes recent discoveries in spinal cord injury pathophysiology and treatment from The Miami Project to Cure Paralysis. It discusses promising neuroprotective and regenerative treatments currently being studied, including hypothermia, stem cells, and Schwann cell transplantation. It also outlines ongoing clinical trials, such as the ARCTIC trial evaluating hypothermia and a proposed phase 1 trial of autologous Schwann cell transplantation in humans with spinal cord injuries. The overall goal is to translate bench research into new clinical applications and improve outcomes for spinal cord injury patients.
This document describes Monica Muthaiya's experimental investigation comparing the tibial and peroneal divisions of the sciatic nerve. The purpose was to examine potential histological differences that could explain why injury to the peroneal division is more common during total joint arthroplasty. Tibial and peroneal nerves from 10 cadavers were sectioned and a portion was manually stretched before staining and analysis using ImageJ software. The hypothesis was that histological differences would be found between the nerves, with the peroneal nerve having a smaller cross-sectional area, since it is less protected and more prone to injury. The results and conclusions aimed to provide insight for physicians on the variations between the nerve divisions and why one may be more susceptible
This document discusses complications that can arise from regional anesthesia. It covers nerve injuries, infections, systemic toxicity from local anesthetics, and issues related to anticoagulation. Specific complications covered include nerve injuries from peripheral nerve blocks, infections from continuous perineural catheters, cardiac and neurological toxicity from local anesthetics, and challenges with anticoagulated patients. Prevention strategies and management approaches are provided.
Zelman vladimir exploring new frontiers of brain preservation and protectionigorod
The document discusses brain preservation and protection strategies. It explores endogenous neuroprotective mechanisms activated after cerebral stress and ischemia that can be harnessed, like ischemic preconditioning. Various preconditioning factors are described, including exercise, caloric restriction, and pharmacologic agents. Improving understanding of the neurovascular unit and modulating cerebral plasticity are proposed for developing new neuroprotective strategies and clinical applications.
The document discusses using machine learning techniques to classify brain images as normal or abnormal. Over 700 unlabeled patient brain images would be labeled and preprocessed, then classified as "brain" or "not brain" using a neural network. Brain images would then be classified as normal or abnormal based on a convolutional neural network trained on labeled data. Related work applied similar techniques using autoencoders and GANs to detect abnormalities like tumors and lesions in MRI images, achieving classification accuracy from 68-62% compared to simpler thresholding methods. The unsupervised models generally outperformed supervised models at identifying anomalies.
The document summarizes research on gait analysis of patients with spina bifida. It describes the three main types of spina bifida and their associated neurological impairments and functional classifications. Instrumental gait analysis is discussed as a tool to objectively measure biomechanical variables during walking. Results from gait analysis can inform treatment through assessing quality of ambulation, effects of orthotics, muscle function, and postoperative changes.
Neurocritical Care Triad - Focused Neurological Examination, Brain Multimodal...Apollo Hospitals
Intensive care is rightly described as “an art of managing intense intricacy” and this situation is further complicated in the care of patients with critical neurological illness. Brain
damage directly related to an insult is primary brain injury (PBI). The cascade of pathobiological events following PBI is known as secondary brain injury (SBI). PBI is most often
irreversible so, the focus of neurocritical care is to prevent, detect and manage SBI.
This document discusses mandibular condylar fractures, including:
1. It provides an overview of the etiology, classification, clinical features, diagnosis, and management of mandibular condylar fractures.
2. Treatment protocols for geriatric and pediatric patients are also discussed.
3. The indications and contraindications of closed and open reduction and fixation techniques for condylar fractures are analyzed in detail.
The document describes the EYE-TRAC Advance study, which is funded by the Department of Defense and conducted by the Brain Trauma Foundation. The study aims to establish a normative database of eye-tracking performance in individuals without concussions and to study abnormal eye-tracking and cognitive performance following a concussion. It will enroll over 5,000 athletes, 5,000 military participants, and several hundred civilians. The study involves baseline eye-tracking and cognitive tests, and follow-up testing including MRI scans for participants who sustain a concussion.
Neurobionics and robotic neurorehabilitationsNeurologyKota
This document discusses neurobionics, robotic neurorehabilitation, and applications of neurobionics. It summarizes key areas including: (1) neurobionics aims to integrate electronics with the nervous system to repair or substitute impaired functions, (2) robotic neurorehabilitation uses robots to assist in rehabilitation processes, and (3) applications of neurobionics include motor interfaces like robotic arms, sensory interfaces like cochlear implants, and treating conditions like epilepsy and Parkinson's disease.
Applied Biomechanics – a multifaceted approach to answering human movement qu...InsideScientific
Experts review the basic principles of biomechanics and how the study of human movement has evolved over time. Presenters highlight examples in applied kinematics, applied kinetics and applied neuromuscular/motor control and demonstrate how methodologies vary depending on the field of study or area of expertise.
Ilsi conference biomed presentation brain game change israel leadership in c...Howard Sterling
Summary:
Neuro-cognitive and degenerative (CNS) diseases, with Alzheimer’s leading, are among the most intractable and costly and distressing diseases. Without effective therapies with minimal side effects, these diseases will break the healthcare systems, patients and caregivers.
Current therapies are inadequate and so many standard pharmaceutical responses have failed in late stage trials.
Only the most innovative solutions will yield effective therapies.
Israel, with its history & culture of scientific innovative innovation, government support & early recognition of the challenges of CNS, is poised to be a leader in effective CNS therapies.
How can we make Israel’s leadership known to the world?
The document discusses using electrodermal activity (EDA) sensors to measure sympathetic nervous system responses as a way to detect stress, arousal, and other internal states in non-speaking individuals. EDA sensors measure sweat gland activity and can indicate arousal levels, with higher EDA associated with increased sympathetic nervous system activation. The document provides examples of using EDA sensors to detect seizures, measure sleep quality, and investigate memory consolidation. EDA measured from the left and right wrists separately may provide insights into responses linked to the left and right amygdala.
Dendritic spine density a measure of cognitive reserveAdonis Sfera, MD
The document discusses measuring dendritic spine density as a potential measure of cognitive reserve. Most neuroprotective agents increase dendritic spine growth by different mechanisms, and their effectiveness can be assessed by their ability to increase spine density. Measuring spine density in cultured neurons from patients may provide insight into an individual's cognitive reserve. Recent studies have also found abnormal spine morphology or numbers in several neuropsychiatric disorders. New software like Imaris can automatically detect and measure spines across large datasets to study mechanisms regulating spine morphology. Patient-specific neurons obtained through induced pluripotent stem cells or transdifferentiation can have their spine density measured once they form networks, providing a method to study cognitive capacity.
Clinico-Demographic Profile of Traumatic Spinal Injury in a Tertiary HospitalLemuelJohnTonogan
As of today, there has been a limited number of studies about the demographic profile of traumatic spinal injuries in our locality and our country. The objective of this study is to determine the clinico-demographic profile of patients with traumatic spinal injury admitted in our institution for the past 10 years. A chart review of 73 patients who satisfied the inclusion criteria with traumatic spinal injuries were reviewed. Traumatic spinal injury in the locality mostly affects ages 46-60 years with a mean age of 53.5. Males were most commonly affected, married and unemployed secondary to fall and motor vehicular accidents. The cervical spine is the most commonly affected area, resulting to an incomplete paraplegia with ASIA D score in most cases. These patients were mostly managed conservatively and improved upon discharge. Strict implementation of traffic rules and fall prevention should be emphasized by the government and the locality, and also increase the awareness of patients at risk for traumatic spinal injuries and its debilitating consequences.
Intraoperative neuromonitoring (IONM) allows surgeons to monitor vulnerable nerves like the facial, recurrent laryngeal, and vagus nerves during head and neck surgery. IONM is done using electromyography to provide real-time information about the functional integrity of nerves. Electrodes are placed on muscles innervated by the nerves of interest and the nerves can be stimulated during surgery to ensure their function is being preserved. IONM helps reduce patient morbidity from nerve injuries during surgery.
Presented at International Workshop on
Frontiers of Neuroengineering,
Brain-machine Interfaces
& Neural Prostheses
Zhejiang University, Hangzhou, China
March 29, 2011
There are over 600 neurological disorders that can cause dysfunction in the brain, spine or nerves. Neuroprosthetics are implantable devices that can replace or support lost neurological function. There are three main types: sensory neuroprosthetics like cochlear implants that restore hearing; motor neuroprosthetics that help control limb movement; and cognitive prosthetics that treat conditions like Alzheimer's. While neuroprosthetics show promise, they also carry risks like infections from brain surgery. Regulations vary depending on the device, but most require clinical trials to demonstrate safety and effectiveness before approval. Further research and international guidelines could help advance this emerging field.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. What?
What’s the problem?
Image Retrieved 9/11/2012 from:
http://computingforsustainability.files.wordpress.com/2011/04/trolley-problem.jpg, modified without permission.
3. What?
What’s the problem?
Image Retrieved 9/11/2012 from: http://computingforsustainability.files.wordpress.com/2011/04/trolley-
problem.jpg,modified without permission.
5. What?
What’s the problem?
Iatrogenic neurological injury in spine surgery
can be caused by:
Surgical
Distraction, compression or blunt trauma
Ischemia of neural structures
Thrombotic events
Anesthetic or Systemic Problems
Ischemia,
hypoxia
hypothermia
cervical extension duri ubation
Positioning
Direct compression
Compromised blood supply
Neck and shoulder positioning
ng int
6. What?
What’s the problem?
What is the incidence of iatrogenic
injury
in elective spine
surgery?
Iatrogenic neurological injuries in elective spinal surgery
without neurophysiological monitoring:
Anterior cervical discectomy – 0.46%
Scoliosis correction - .23-3.2%
Intramedullary tumor resection - >23.8%
Vauzelle C, Stagnara P, Jouvinroux P al monitoring of s y during spinal surgery.
Clin Orthop Relat Res 1973;93:173-8
. Function pinal cord activit
0
7. Why?
Why avoid iatrogenic injury?
To improve or maintain quality of life.
(WHO - HRQOL)
People with spinal cord injury (SCI):
report lower sense of well-being
score lower on physical, mental, and social health
domains
Dijkers, M: Quality of life of individuals
measurement, and research findings. J.
3, May/June 2005, Pages 87-110. Retriev
of conceptualization,
ab Res ent Number 1, Volume 42 Number
http://www.rehab.research.va.gov/jour/05/ uppl1/dijkers.html42/3s
with
Reh
ed 9/
spinal
11/12
cord
& De
from
injury
v, Sup
: A re
plem
view
8. Why?
Why avoid iatrogenic injury?
To improve or maintain quality of life. (WHO – HRQOL)
“Life expectancies for persons with SCI continue to
increase, but are still somewhat below life expectancies
for those with no SCI.”
National Spinal Cord Injury Statistical Center, Birmingham, A Facts and Figures at a
Glance, February 2012, retrieved 9/11/12 at
https://www.nscisc.uab.edu/PublicDocuments/fact_figures_docs/Facts%202012%20Feb%20Final.pdf
labama, Spinal Cord Injury
9. Why?
Why avoid iatrogenic injury?
Reduce the costs associated with iatrogenic injury.
The average yearly health care and living expenses directly
attributable to SCI was $69,204 in February 2012 dollars.
These figures do not include any in ch as losses
in wages, fringe benefits and produ vity.
National Spinal Cord Injury Statistical Center, Birmingham, Alabama, Figures at a Glance,
February 2012, retrieved Sept. 11, 20112 at https://www.nscisc.uab.edu/PublicDocuments/fact_figures_docs/Facts
%202012%20Feb%20Final.pdf
dir
cti
Spina
ect
l Cord
co
Injur
sts
y Fac
su
ts and
10. How?
How can we avoid iatrogenic injury?
Timely detection of changes in
neurologic status allows
therapeutic action to ameliorate
or avoid neurologic eficits.d
11. How?
How can we detect changes in
neurologic status?
Functional vs. Structural Assessment
Structural Assessment
Radiography
Sonography
Visualization
12. The Role of Intraoperative Neuromonitoring
How?
How can we detect changes in
neurologic status?
Function Assessment
Using provocative and non-provocative
techniques.
Intraoperative Neurophys logic Monitoring
(IONM)
io
13. The Role of Intraoperative Neuromonitoring
How?
How is IONM performed?
Electrophysiologic Assessments
Non-Provocative
Spontaneous electromyography
Electroencephalography (EEG)
Provocative
(sEMG)
Triggered electromy rap EMG)
Electroencephalo aph EEG)
Evoked Potentials (EP)
Somatosensory (SSEP)
Motor (MEP)
Nerve Conduction Study (NCS)
gr
og
y (
hy (t
14. The Role of Intraoperative Neuromonitoring
How?
How effective is IONM?
Efficacy of IONM in Cervical Spine
SurgerySomatosensory evoked potentials
sensitivity - 52% (+ correctly ID'd)
specificity - 100% (- correctly ID'd)
PPV - 100% (true +/+calls)
NPV -
Motor evoked
97% (true -/- calls)
potentials
sensitivity -
specificity -
100%
96%
PPV -
NPV - %
Electromyography
sensitivity - 46%
specificity - 73%
PPV -
NPV -
3%
97%
Kelleher MO, Tan G, Sarjeant R, Fehlings MG: Predictive value of intraoperative neurophysiological monitoring during cervical spine surgery: a prospective analysis
of 1055 consecutive patients. J Neurosurg Spine. 2008 Mar;8(3):215-21.
96
10
%
0
15. The Role of Intraoperative Neuromonitoring
How?
How effective is IONM?
Efficacy of IONM in Thorocolumbar
Spine Surgery (nerve
SSEPs
root emphasis)
sensitivity
specificity
sEMG
sensitivity %
specificity %- 23.7
-
-
-
29
95
10
%
%
0
16. The Role of Intraoperative Neuromonitoring
How?
How effective is IONM?
Multimodal IONM reduces the relative risk of post-
operative neurological complications in spine surgery by an
estimated 49.4% at a mean cost of $63,387 perneurological
deficit averted.
Ney JP, Van der Goes DN, Watanabe JH: Cost-effectiveness of intraoperati uroph ological monitoring for spinal
surgeries: Beginning steps, Clinical Neurophysiology, Volume 123, Is mber 2012sue 9,
ve ne
Pages 1705
ysi
-1707, Septe
17. The Role of Intraoperative Neuromonitoring
When?
When is IONM appropriate?
Identify iatrogenic nervous system compromise in a
timely fashion.
Ongoing monitoring
Identify neural structures through specific testing
procedures.
Time-Specific assessm
Identify when iatrogenic i jury cur d in
experimental procedures.
Ongoing monitoring
n
ent
oc re
18. The Role of Intraoperative Neuromonitoring
Where?
Where can IONM be performed?
On the hospital floors
In Pre-Op Holding
In the Operating Room
19. The Role of Intraoperative Neuromonitoring
Who?
Who provides IONM?
Technologists – Technical Component
•Associate and Bachelor Degrees.
•Trained in the technical aspects of data collection.
•Lack training and knowledge to provide
interpretation, diagnosis and treatment
Credentials:
•ABRET - American Boar Registrati of
Electroencephalograph and E ked Potential
Technologists
•CNIM - Certificate in Neurophysiologic
Intraoperative Monitoring
ic
d of
vo
on
20. The Role of Intraoperative Neuromonitoring
Who?
Who provides IONM?
Non-Physician Surgical Neurophysiologist – Professional
Component
•Non-MD providers with Doctorate Degrees.
•Technical Support for CNIMs.
•Technical Component
•Site-specific credentials may allow:
Supervision duties
Interpretation with tr ent ggestions to
surgical team M.D.s.
Credentials:
•ABNM – American Board of Neurophysiologic
Monitoring
•Diplomat – D.ABNM
eatm su
21. The Role of Intraoperative Neuromonitoring
Who?
Who provides IONM?
Clinical Neurophysiologist – Medical Component
Medical Doctors – M.D. and D.O. With specific
certification.
Interpretation
Diagnosis
Treatment
Credentials: Certification from
ABPN - American Board of sychiatr nd Neurology
ABCN - American Board of al Neurophysiology
ABEM - American Board of mergency
ABNM – American Board of Neurophysiologic
Monitoring
E Medicine
; P
Cli
nic
y a
22. The Role of Intraoperative Neuromonitoring
Anatomy Review
Sensory Input
Posterior Dorsal Column-
Lemniscal Tract
Conveys touch, vibration
and proprioception
information to the brain.
Retrieved on 9/12/12 from; http://en.wikipedia.org/wiki/File:Gray759.png
23. The Role of Intraoperative Neuromonitoring
Anatomy Review
Corticospinal Tract
Voluntary skilled
activity
Pre-central gyrus of
cortex to spinal cord
without interruption
Retrieved on 9/12/12 from:http://en.wikipedia.org/wiki/File:Gray764.png
24. The Role of Intraoperative Neuromonitoring
Anatomy Review
Spinal Cord Anatomy
Blood supply of dorsal
1/3
of spinal cord via the
two
posterior spinal arteries.Blood supply of the
anterior 2/3 of spinal
cordvia the single anterior
spinal artery.
Retrieved on 9/12/2012 from; http://en.wikipedia.org/wiki/File:Medulla_spinalis_-_tracts_-
_English.svg
25. The Role of Intraoperative Neuromonitoring
Anatomy Review
Anterior Spinal Artery
Spinal cord blood
supply and
regions
watershed
Nuwer MR, Handbook of Clinical Neurophysiology Volume 8; Intraoperative
Monitoring of Neural Function.(2008). Elsevier, Daube and Mauguiere Eds. Pg 58
26. The Role of Intraoperative Neuromonitoring
Anatomy Review
Nerve Roots
Retrieved on 9/12/2012 from http://en.wikipedia.org/wiki/File:Spinal_nerve.svg
27. The Role of Intraoperative Neuromonitoring
Anatomy Review
Intervertebral
Foramen
Retrieved on 9/12/12 from
http://upload.wikimedia.org/wikipedia/commons/a/ad/Foraminaintervertebr
alia.png
28. The Role of Intraoperative Neuromonitoring
Electrophysiological Techniques in IONM
Evoked Potentials (EP)
Somatosensory (SSEP)
Motor (MEP)
Electromyography
Spontaneous EMG (sEMG)
Triggered EMG (tEMG)
low r ance spine surgeryNerve Conduction Study (NCS
low relevance to spine surgeryElectroencephalography (EEG)
elev to
29. The Role of Intraoperative Neuromonitoring
Electrophysiological
Techniques in IONM
Evoked Potentials (EP)
Somatosensory (SSEP)
Stimulation:
electrical, peripheral mixed nerve.
Recording:
neurogenic. peripheral,
subcortical, cortical.
Use:
monitor dorsal spinal cord
(afferent) and afferent peripheral
nerves
30. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
Electrophysiological
Techniques in IONM
Evoked Potentials (EP)
Somatosensory (SSEP)
Stimulation:
electrical, peripheral
mixed nerve
Recording:
neurogenic.
peripheral,
subcortical, cortical
Retrieved on 9/12/12 from; http://en.wikipedia.org/wiki/File:Gray759.png
31. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
Electrophysiological
Techniques in IONM
Evoked Potentials (EP)
Motor (MEP)
Stimulation:
Electrical or
Magnetic
Recording:
Neurogenic - Spinal
Cord
Myogenic - Muscles
of Interest
Use:
Monitor anterior
spinal cord and
efferent peripheral
nerves
Retrieved on 9/12/12 from:http://en.wikipedia.org/wiki/File:Gray764.png
32. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
Electrophysiological Techniques in IONM
Electromyography
Recording and interpretation of muscle activityin
real time.
Spontaneous EMG (sEMG)
Stimulation:
None
Recording:
Continuous recording of uscles
innervated by nerve roots at risk
Surface or needle electrodes
Use:
Detect mechanical nerve root irritation
m
33. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
Electrophysiological Techniques in IONM
Electromyography
Recording and interpretation of muscle activity in real
time
Triggered EMG (tEMG)
Stimulation:
electrical
Recording:
Brief, time-locked uscle activity
Use:
Differentiate sue
Compute nerve conduction velocity
(NCV)
Assess pedicle screw integrity
tis
m
34. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
Let us look at IONM in:
Spinal Deformity Surgery
Spinal Decompression Surgery
Anterior Cervical Discectomy Fu onand si
35. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Deformity Surgery
Times of Risk:
Induction: Low unless spinal instability
Positioning: Low unless symptoms easily provoked
Surgical: Significant dur g deformity correction
pedicle screw implantation
in
36. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Deformity Surgery
Structures at Risk:
Primary:
Spinal cord
Mechanism: Cord distraction and compression,
ischemia
Nerve Roots
Mechanism: Trauma, compre on, ardware
Secondary:
Peripheral nerves and brachial plexus
Mechanism: Stretch and compression
ssi h
37. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Deformity Surgery
Modalities Monitored:
SSEP – dorsal spinal cord and peripheral nerves
MEP – ventral spinal cord and peripheral nerves
sEMG, tEMG – nerve roots
38. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Deformity Surgery
63 year old female with 20 year history of C5-6 tetraplegia with
partial zone preservation to left C7 myotome, and post traumatic
tethered spinal cord due to MVA.
Planned procedure: cervical laminectomy, spinal c d
untethering, expansion duraplasty.
Spoiler Alert: These data suggested the possibil ansient
changes in the left side sensory and motor neurological status
during this procedure.
ity
or
of tr
39. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in Spinal Deformity Surgery
63 year old female with 20 year history of C5-6 tetraplegia
Prepositioning Data – Ulnar and Tibial SSEP
40. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in Spinal Deformity Surgery
63 year old female with 20 year history of C5-6 tetraplegia
Prepositioning Data - MEP
41. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in Spinal Deformity Surgery
63 year old female with 20 year history of C5-6 tetraplegia
9:20 - Post-positioning Data – Ulnar SSEP
9:29 – Reposition left arm
9:39 – No Ulnar SSEP Cortical Response. Neck repositioned
9:49 – Left Ulnar stimulation moved to elbow.
9:59 – Patient returned to bed.
10:30 – Prone on OR table.
10:33 – Median Stimulation in Ulnar Test
10:46 – Patient returned to bed.
11:02 – Surgery aborted.
42. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in Spinal Deformity Surgery
63 year old female with 20 year history of C5-6 tetraplegia
Post-positioning Data – MEP
9:20 - Post-positioning Data – Ulnar SSEP
9:29 – Reposition left arm
9:39 – No Ulnar SSEP Cortical Response. Neck repositioned.
9:49 – Left Ulnar stimulation moved to elbow.
9:59 – Patient returned to bed.
10:30 – Prone on OR table.
10:46 – Patient returned to bed.
11:02 – Surgery aborted.
43. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in Spinal Deformity Surgery
63 year old female with 20 year history of C5-6
tetraplegia
Surgery was aborted.
Clinical exam in post-op recovery demonstrated
no new neurolog al deficits.ic
44. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Decompression Surgery
Times of Risk:
Induction: Low
Positioning: Moderate for mechanical irritation of
nerve
root
Surgical: Significant during decompre on.ssi
45. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Decompression Surgery
Structures at Risk:
Primary:
Nerve roots
Mechanism: Trauma, stretching
Secondary:
Spinal cord
Mechanism: Ischemia
Peripheral nerves and brachial ple s
Mechanism: Compression, stretching
xu
46. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Decompression Surgery
Modalities Monitored:
sEMG – nerve roots
SSEP – spinal cord and peripheral nerves
tEMG, MEP (optional)
47. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Decompression Surgery
68 year old female with L4-5 DDD, spondylolisthesis, spinal stenosis, radiculopathy
Procedure: PSF, PLIF L4-5
Laminectomy in progress.
48. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Decompression Surgery
68 year old female with L4-5 DDD, spondylolisthesis, spinal stenosis, radiculopathy
Procedure: PSF, PLIF L4-5
Rasp on End-plate prior to cage implantation.
49. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Decompression Surgery
68 year old female with L4-5 DDD, spondylolisthesis, spinal
stenosis, radiculopathy
Procedure: PSF, PLIF L4-5
Triggered EMG – Pedicle Screw Stimulation Thresholds
Acceptable Limits > 8 mA.
Site Left ght
L4 screw
L5 screw
L5 nerve
8 mA (2nd, 15 mA) mA
36 mA mA
A
Ri
30
33
0.2 m
50. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Spinal Decompression Surgery
68 year old female with L4-5 DDD, spondylolisthesis, spinal stenosis, radiculopathy
Procedure: PSF, PLIF L4-5
Examine left L4 pedicle due to low screw threshold.
51. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Anterior Cervical Discectomy and Fusion
Times of Risk:
Induction: Possibly Significant
Positioning: Possibly Signifi ant
Surgical: Signific tan
c
52. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Anterior Cervical Discectomy and Fusion
Structures at Risk:
Primary:
Spinal Cord, Cervical Nerve Roots
Secondary:
Recurrent Laryngeal erve, Brachial PlexusN
53. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Anterior Cervical Discectomy and Fusion
Modalities Monitored:
MEP
SSEP
Recurrent Laryng erve sEMG
sEMG
eal (CN X) N
54. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Anterior Cervical Discectomy and Fusion
59 year old male
Dx: DDD C5-6
Procedure: Artificial Disc C5-6
55. The Role of Intraoperative Neuromonitoring
David Barnkow, AuD, DABNM, CNIM
IONM in
Anterior Cervical Discectomy and Fusion
Artificial Disc C5-6