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Spine surgery

  • Situation

    The intraoperative neuromonitoring in spine surgery belongs to one of the first neurophysiological measurements applied during surgery replacing the previously inevitable wake-up test.

    Monitoring of the nerve pathways can be used particularly in discectomies, in scoliosis or spinal surgeries, during root decompressions or pedicle screw fixations.

  • Neuromonitoring

    The most important nerve structures for the entire body run in the spinal cord: the descending motor tracts that are primarily responsible for the transmission of impulses from the brain to the muscles as well as the ascending sensory tracts that transmit signals from the sensory organs of the periphery to the brain.

    In principle one distinguishes between monitoring of motor pathways using EMG (electromyography) or MEP (motor evoked potentials) and monitoring of ascending pathways using SEP (somatosensory evoked potentials).

  • EMG / MEP

    In electromyography the electrical stimulation is done directly in the surgery field and the signals are recorded from peripheral muscles. Motor evoked potentials are triggered by transcranial or direct cortical stimulation. Here the signals are recorded from the appropriate muscles as well but nowadays often epidural (D-waves) in addition.

     

  • SEP

    During SEP measurements the peripheral nerves (e.g. tibial nerve) are, in contrary, stimulated transcutaneously and the signals are cortically or subcortically recorded. Hence supervision of the sensory pathways that run through the surgical field is possible.

    A combination of different methods (modalities) can be realized as well with modern neuromonitors so that a largely reliable assessment of the current status during surgery and therefore safety is attained.

  • Pedicle Screw Stimulation

    For pedicle screw fixations we offer special stimulation probes that allow stimulation in the drill hole itself or on the instruments during the drilling of holes or screwing. It becomes critical when the stimulation leads to a motor unit action potential (MUAP) on any one of the recorded target muscle, because then a motor nerve is very close by, has been touched or even bruised.

     

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