title: Neurophysiological Monitoring During Spinal Cord Stimulator Placement Surgery.
abstract: OBJECTIVE
  The objective of this retrospective study was to study the frequency of intraoperative neuromonitoring (IONM) alerts during the spinal cord stimulator (SCS) placement surgery, postoperative neurological complications and effectiveness of Somatosensory evoked potential (SSEP) and electromyography (EMG) methods to determine laterality of the SCS lead placement.
  
  
  METHODS
  Records of 111 consecutive SCS placement surgeries monitored by a commercial IONM company between August 1, 2013 and December 31, 2013 were reviewed. IONM alerts, surgical interventions, and patient outcomes were assessed.
  
  
  RESULTS
  Significant decreases of lower extremity SSEPs following the placement of the SCS paddle electrodes into the epidural space were recorded in two (1.9%) patients prompting alerts to the surgeons and removal of the electrode. Somatosensory system dysfunction due to stimulated limb malpositioning was identified by continuous SSEP in four cases (3.8%). All waveform changes resolved and SSEP waveforms returned back to baselines in all six patients after adjustments were made. There was no evidence of sustained neurological injury in any patients in this study. The location of the stimulator was adjusted based on IONM feedback in 8/43 (18.6%) cases.
  
  
  CONCLUSIONS
  IONM is an effective tool in detecting potential neurological event and facilitating lead placement and potentially avoiding revision surgery.
authors: Biotronic NeuroNetwork, Ann Arbor, MI, USA.
authors: Arvydas A
authors: AA
authors: Tamkus
authors: Biotronic NeuroNetwork, Ann Arbor, MI, USA.
authors: Andrew F
authors: AF
authors: Scott
authors: Department of Neurosurgery, Stanford University, Stanford, CA, USA.
authors: Fahd R
authors: FR
authors: Khan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004599:Electric Stimulation Therapy / Q000295:instrumentation / Q000379:methods*; D004576:Electromyography; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009437:Neuralgia / Q000503:physiopathology / Q000628:therapy*; D064926:Neurophysiological Monitoring; D012189:Retrospective Studies; D013116:Spinal Cord / Q000502:physiology*; D055815:Young Adult
keywords: Intraoperative neuromonitoring; neurologic complications; somatosensory evoked potentials; spinal cord stimulator