title: Using intraoperative electrophysiologic monitoring as a diagnostic tool for determining levels to decompress in the cervical spine: a case report.
abstract: OBJECTIVE
  This report describes the clinical usefulness of using intraoperative electrophysiologic monitoring as a diagnostic tool for determining levels to decompress in the cervical spine.
  
  
  METHODS
  A 59-year-old man was experiencing intractable neck and left upper extremity pain after sustaining a second spinal injury. (The patient had previously undergone an anterior cervical discectomy and fusion at C5-C6 with plating to treat injuries from a motor vehicle accident.) On examination, he had no motor changes but did have pain in his left upper extremity and numbness of the left thumb and index finger. A myelogram and postmyelogram computed tomography scan revealed a disc herniation at C4-C5 with severe neural foraminal disease on the left side of C4-C5 and residual posterior osteophytes with questionable neuroforaminal stenosis on the left side of C5-C6. Routine electrophysiologic studies showed mild irritation of the left biceps (left C5-C6 nerve root), indicating radiculopathy. The patient was admitted with plans to undergo plate removal, exploration of the fusion at C5-C6, and an anterior cervical discectomy with foraminotomies and fusion at C4-C5. Continuous free-running electromyography was recorded during the surgical procedures.
  
  
  RESULTS
  The surgery was performed as planned; however, the irritation observed at C5-C6 did not subside. Relying on this information, as an extension of the patient's history and physical examination, a decision was made to remove the previous fusion at C5-C6 and to explore the left C6 root. A very tight neural foramen was found at this level. After decompression and foraminotomy, no electrophysiologic activity above baseline was recorded at C5-C6. The patient was then fused and plated from C4 to C6, and awoke with no left upper extremity pain. Neurologic examination was normal immediately after surgery and at 3 months follow-up.
  
  
  CONCLUSIONS
  Intraoperative, continuous free-running electromyography proved clinically effective in determining the course of surgery.
authors.affiliation: Orthopaedic and Spine Surgery of Atlanta LLC, Atlanta, GA 30327, USA. jlchappuis@aol.com
authors.forename: James L
authors.initials: JL
authors.lastname: Chappuis
authors.forename: Gregory
authors.initials: G
authors.lastname: Johnson
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D004568:Electrodiagnosis / Q000379:methods*; D004576:Electromyography / Q000379:methods / Q000592:standards; D004594:Electrophysiology / Q000379:methods / Q000592:standards; D006801:Humans; D016268:Internal Fixators / Q000592:standards; D007405:Intervertebral Disc Displacement / Q000209:etiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D019547:Neck Pain / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D009431:Neural Conduction / Q000502:physiology; D011237:Predictive Value of Tests; D011843:Radiculopathy / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012086:Reoperation / Q000379:methods; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods / Q000592:standards; D013124:Spinal Injuries / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013127:Spinal Nerves / Q000293:injuries / Q000503:physiopathology; D013130:Spinal Stenosis / Q000209:etiology / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome