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Intraoperative Neuromonitoring in a case of Cervical stenosis with posterior decompression
Upper Chesapeake Medical Center Spine conference
8/18/17
63 year old man
cc: LBP
HPI: Sx for 14 years. Rx with PT, chiropractor, massage, epidural
steroid injections, .
In the last 2-3 months c/o difficulty walking, loss of balance,
numb/pain thumb, IF, MF and radial hands. “Legs do not work
right”. Feet burning.
PMH: L knee scope, HTN, chol
Meds: amlodipine besylate, losartan , K
SH: civil servant, married, grown children
Exam: ataxia, waddling gait, B foot slap, L ankle 3-4 beats of
unsustained clonus, R no clonus, negative Hoffmans, full painless
ROM neck, 5/5 motor U and LE, no sens.
MRI lumbar spine : mild DDD, stenosis L3L5
RL
c2c3
c3c4
c4c5
c5c6
c6c7
PROBLEM LIST:
1. Severe ataxia
2. C6 radiculopathy
3. Stenosis C4C5>C3C4>C5C6
4. C4C5 spondylolisthesis
5. Myelomalacia C5C6
• Stagnara wake up test
• SSEP: somatosensory evoked potentials
• tcMEP: transcranial motor evoked potentials
• nMEP: neurogenic MEP spinal cord
• sEMG: spontaneous EMG
• tEMG: triggered EMG
MAP<60
Amplitude 50%
Latency 10%
: poor signals RLE
ost flip no change, prone position
nutes after laminectomy B 90% loss of signals
eturned while closing
.6L, EBL: 200cc, U/O: 250cc, op time: 3h20min
RR: 0/5 R motor, normal face, L
• RR: 0/5 R motor upper and
lower, normal face, L 4/5
motor upper and lower
RR: 0/5 R motor, normal face, L 4/5 motor
C4C5
6weeks postop
thanks
Lecture cervical stenosis neuromonitoring 2017

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Lecture cervical stenosis neuromonitoring 2017

  • 1. Intraoperative Neuromonitoring in a case of Cervical stenosis with posterior decompression Upper Chesapeake Medical Center Spine conference 8/18/17
  • 2. 63 year old man cc: LBP HPI: Sx for 14 years. Rx with PT, chiropractor, massage, epidural steroid injections, . In the last 2-3 months c/o difficulty walking, loss of balance, numb/pain thumb, IF, MF and radial hands. “Legs do not work right”. Feet burning. PMH: L knee scope, HTN, chol Meds: amlodipine besylate, losartan , K SH: civil servant, married, grown children Exam: ataxia, waddling gait, B foot slap, L ankle 3-4 beats of unsustained clonus, R no clonus, negative Hoffmans, full painless ROM neck, 5/5 motor U and LE, no sens. MRI lumbar spine : mild DDD, stenosis L3L5
  • 3.
  • 4. RL
  • 5.
  • 6.
  • 7.
  • 10. c4c5
  • 11. c5c6
  • 12. c6c7
  • 13. PROBLEM LIST: 1. Severe ataxia 2. C6 radiculopathy 3. Stenosis C4C5>C3C4>C5C6 4. C4C5 spondylolisthesis 5. Myelomalacia C5C6
  • 14.
  • 15.
  • 16. • Stagnara wake up test • SSEP: somatosensory evoked potentials • tcMEP: transcranial motor evoked potentials • nMEP: neurogenic MEP spinal cord • sEMG: spontaneous EMG • tEMG: triggered EMG
  • 17.
  • 19.
  • 20.
  • 21.
  • 22.
  • 24. : poor signals RLE ost flip no change, prone position nutes after laminectomy B 90% loss of signals eturned while closing .6L, EBL: 200cc, U/O: 250cc, op time: 3h20min
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35. RR: 0/5 R motor, normal face, L • RR: 0/5 R motor upper and lower, normal face, L 4/5 motor upper and lower RR: 0/5 R motor, normal face, L 4/5 motor
  • 36.
  • 37. C4C5