Efficacy of head repositioning in restoration of electrophysiological signals during cervical spine procedures (original) (raw)

Journal of Clinical Neurophysiology, 2016

Abstract

Intra-operative Neuro-Monitoring (IONM) is commonly used during cervical spine surgeries. Patient positioning with head extension is associated with risk of neurological damage. This study evaluates the frequency of loss of neurophysiological potentials during head positioning, the usefulness of head repositioning to restore the potentials, and the effect on neurological outcome. We retrospectively reviewed consecutive cervical spine surgeries performed at the Israel Spine Center, Assuta Medical Center, during 2006-2013. Surgeries performed with neuromonitoring (transcranial-electric motor evoked potentials [tcMEP], somatosensory evoked potentials [SSEP], electromyographic recordings [EMG]) were included. Demographic data, medical history, findings at neurological examination and imaging, electrophysiological data recorded during surgery, and neurological outcomes were collected and analyzed. 381 patients met inclusion criteria. Loss of potentials was detected in nine patients during patient positioning and repositioning was undertaken with the aim of restoring electrophysiological signals. In 5/9 patients, repositioning resulted in immediate reappearance of potentials; in 1/5, potentials were affected again during decompression. In 4/9 repositioning did not immediately restore electrophysiological signals; in 1/4 potentials reappeared later during the decompression and in 3/4 potentials had not recovered till the conclusion of surgery. There were new neurological deficits in 2/9, including one patient with loss of potential that was not restored with repositioning and the one in whom potential was restored but lost again during decompression. IONM is an efficient tool to alert the surgical team to potential neurological damage. Head reposition often restores the electrophysiological signals with possible prevention of impending sequelae.

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