title: Prospective Study of the Use of Intraoperative Neuromonitoring in Determining Post-Operative Energy Requirements and Physiologic Midline in Spinal Cord Stimulation.
abstract: BACKGROUND
  Intraoperative neuromonitoring (IONM) through electromyography (EMG) studies has been shown to be a safe, effective way to determine the laterality of the spinal cord and guide electrode placement during spinal cord stimulation (SCS). However, the use of IONM to predict post-operative energy requirements and midline has not been examined and offers a new avenue to streamline programming and device selection. Further, the impact of cerebrospinal fluid (CSF) thickness on intraoperative and post-operative amplitudes is understood but has not been explicitly characterized.
  
  
  METHODS
  A total of 24 patients undergoing SCS implantation for chronic pain had intraoperative EMG studies performed to determine physiologic midline. The intraoperative midline was compared to the midline determined on post-operative day 1 based on paresthesia patterns during programming. For patients who had thoracic leads placed, the amplitudes needed to induce abdominal and extremity lateralization during SCS placement were compared with the intensities needed to induce therapy at post-operative day 1. Additionally, we examined whether CSF thickness, body mass index, diabetes, drug use, and smoking correlated with intraoperative and post-operative amplitudes.
  
  
  RESULTS
  Intraoperative EMG was able to predict post-operative paresthesia-based midline in 70.83% of patients. There was a statistically significant relationship between the intraoperative intensity needed to induce extremity lateralization with the post-operative intensity to induce therapy (p = 0.009) as well as the intraoperative intensity needed to stimulate abdominals with the post-operative intensity (p = 0.033). There was also a relationship seen between CSF thickness and the post-operative energy requirements in patients (p = 0.039).
  
  
  CONCLUSIONS
  EMG accurately predicts post-operative energy requirements and midline in SCS patients. While 29.17% of patients did not have a match between their intraoperative and post-operative midlines, EMG testing was still valuable in guiding electrode placement and providing information to predict post-operative intensities. Additionally, CSF thickness correlated with amplitude settings on the first post-operative day.
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Collison
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.|Department of Neurology, Albany Medical Center, Albany, NY, USA.|Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Prusik
authors.affiliation: Impulse Monitoring, Inc., Columbia, MD, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Paniccioli
authors.affiliation: Impulse Monitoring, Inc., Columbia, MD, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Briotte
authors.affiliation: Impulse Monitoring, Inc., Columbia, MD, USA.
authors.forename: Rachael
authors.initials: R
authors.lastname: Grey
authors.affiliation: Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Feustel
authors.affiliation: Department of Neurosurgery, Albany Medical Center, Albany, NY, USA.|Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, USA.
authors.forename: Julie G
authors.initials: JG
authors.lastname: Pilitsis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002555:Cerebrospinal Fluid / Q000502:physiology*; D059350:Chronic Pain / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004567:Electrodes, Implanted; D004576:Electromyography / Q000379:methods; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D062187:Spinal Cord Stimulation / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Intraoperative neuromonitoring; spinal cord stimulation