Justin W Silverstein1,2, Eric Matthews3, Laurence E Mermelstein4, Hargovind DeWal4. 1. Neuro Protective Solutions, LLC, 140 Adams Ave, Ste B13, Hauppauge, NY, 11788, USA. wiredneuro@gmail.com. 2. A.T. Still University, Mesa, AZ, USA. wiredneuro@gmail.com. 3. A.T. Still University, Mesa, AZ, USA. 4. Long Island Spine Specialists, PC, Commack, NY, USA.
Abstract
BACKGROUND CONTEXT: Somatosensory evoked potentials (SSEPs) are effective in detecting upper extremity positional injuries; however, causal factors for which patient population is most at risk are not well established. PURPOSE: To review causal factors for intraoperative SSEP changes due to patient positioning. STUDY DESIGN: A case series with retrospective chart analysis was performed. PATIENT SAMPLE: 398 patient charts and intraoperative neurophysiological monitoring data from patients who underwent thoracolumbar and lumbosacral spine surgery were reviewed in a consecutive sequence from 2012 to 2013. OUTCOME MEASURES: Adverse events (AE) with the upper extremity SSEP recordings were compared to the independent variables, sex, positioning, length of procedure, and body habitus. METHODS: Thoracolumbar and lumbosacral spine surgeries using contemporaneous ulnar and median nerve SSEPs were reviewed. The one-way analysis of variance (ANOVA) test, Chi-square, and independent samples t test were used to determine statistical significance in having an upper extremity SSEP AE to the aforementioned independent variables. RESULTS: The sample consisted of 209 males (52.5 %) and 189 females (47.5 %) (n = 398). AE to the upper extremity SSEP was seen in 44 patients. Sex was found to be statistically significant for isolated ulnar nerve AE (P ≤ 0.001) with males being most at risk (87.5 %). AE for isolated median nerve SSEP was statistically significant for supine and prone positions (P = 0.043). Length of procedure was statically significant for isolated ulnar nerve SSEP AE (P = 0.039). BMI was statistically significant for generalized upper extremity SSEP AE (P = 0.016), as well as isolated ulnar SSEP AE (P = 0.006), isolated median SSEP AE (P ≤ 0.001) and contemporaneous median and ulnar SSEP AE of the same limb (P ≤ 0.001). CONCLUSION: Sex, patient positioning, length of procedure, and BMI are determinants for upper extremity neural compromise during thoracolumbar and lumbosacral spine surgeries.
BACKGROUND CONTEXT: Somatosensory evoked potentials (SSEPs) are effective in detecting upper extremity positional injuries; however, causal factors for which patient population is most at risk are not well established. PURPOSE: To review causal factors for intraoperative SSEP changes due to patient positioning. STUDY DESIGN: A case series with retrospective chart analysis was performed. PATIENT SAMPLE: 398 patient charts and intraoperative neurophysiological monitoring data from patients who underwent thoracolumbar and lumbosacral spine surgery were reviewed in a consecutive sequence from 2012 to 2013. OUTCOME MEASURES: Adverse events (AE) with the upper extremity SSEP recordings were compared to the independent variables, sex, positioning, length of procedure, and body habitus. METHODS: Thoracolumbar and lumbosacral spine surgeries using contemporaneous ulnar and median nerve SSEPs were reviewed. The one-way analysis of variance (ANOVA) test, Chi-square, and independent samples t test were used to determine statistical significance in having an upper extremity SSEP AE to the aforementioned independent variables. RESULTS: The sample consisted of 209 males (52.5 %) and 189 females (47.5 %) (n = 398). AE to the upper extremity SSEP was seen in 44 patients. Sex was found to be statistically significant for isolated ulnar nerve AE (P ≤ 0.001) with males being most at risk (87.5 %). AE for isolated median nerve SSEP was statistically significant for supine and prone positions (P = 0.043). Length of procedure was statically significant for isolated ulnar nerve SSEP AE (P = 0.039). BMI was statistically significant for generalized upper extremity SSEP AE (P = 0.016), as well as isolated ulnar SSEP AE (P = 0.006), isolated median SSEP AE (P ≤ 0.001) and contemporaneous median and ulnar SSEP AE of the same limb (P ≤ 0.001). CONCLUSION: Sex, patient positioning, length of procedure, and BMI are determinants for upper extremity neural compromise during thoracolumbar and lumbosacral spine surgeries.
Authors: Ihab R Kamel; Elizabeth T Drum; Stephen A Koch; Joseph A Whitten; John P Gaughan; Rodger E Barnette; Woodrow W Wendling Journal: Anesth Analg Date: 2006-05 Impact factor: 5.108
Authors: Christopher Mikhail; Zach Pennington; Paul M Arnold; Darrel S Brodke; Jens R Chapman; Norman Chutkan; Michael D Daubs; John G DeVine; Michael G Fehlings; Daniel E Gelb; George M Ghobrial; James S Harrop; Christian Hoelscher; Fan Jiang; John J Knightly; Brian K Kwon; Thomas E Mroz; Ahmad Nassr; K Daniel Riew; Lali H Sekhon; Justin S Smith; Vincent C Traynelis; Jeffrey C Wang; Michael H Weber; Jefferson R Wilson; Christopher D Witiw; Daniel M Sciubba; Samuel K Cho Journal: Global Spine J Date: 2020-01-06