Neuromonitoring of an experimental model of clip compression on the spinal nerve root to characterize acute nerve root injury

I. Ming Jou, Kuo-An Lai

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives. To evaluate the sensitivity of an electromonitoring method in acute nerve root injury, and to determine a proposed criterion for irreversible electrophysiologic degradation. Study Design. Acute nerve root injury was induced by a clip compression model in rabbits, mimicking nerve root injury by a transpedicular screw. A common neuromonitoring technique, spinal somatosensory-evoked potential, was used to study the electrophysiologic change during the procedure. Summary of Background Data. With the advent of the transpedicular screw system, increased risk of injury to the spinal root because of the passage of screws is not unexpected. Although both an experimental model and a clinical application in intraoperative neuromonitoring of spinal cord function have been established, the value of neuromonitoring of an acute spinal root injury remains obscure. Several neurophysiologic surveillance techniques have been used successfully to monitor the potential injury to the spinal cord during orthopedic procedures around the spinal cord and spinal column. Spinal somatosensory- evoked potential, which has the advantages of high amplitude and quick recording time, is used to detect nerve root impairment during the insertion of transpedicular screws. Methods. Experimental acute nerve root injury was induced in rabbits by direct hemostatic clip compression on the nerve root (S1) during different time intervals. Spinal somatosensory-evoked potential elicited by stimulating the sciatic nerve and recorded from a needle electrode at the L6-L7 interspinous ligament was monitored immediately before and after compression. Results. Spinal somatosensory-evoked potential is sensitive enough to detect the compromise of a single nerve root and that a decrease in the amplitude is the most reliable and sensitive sign. With this model, there was a statistically significant correlation between the compression time and reduction of amplitude and delay of latency. The critical criterion for irreversible electrophysiologic change was an amplitude loss of more than 20% and a delay in latency immediately after nerve root compression. Conclusions. It was concluded that spinal somatosensory-evoked potential can provide immediate feedback of nerve root injury and should be considered for use during the dynamic phase of transpedicular screw insertion.

Original languageEnglish
Pages (from-to)932-940
Number of pages9
JournalSpine
Volume23
Issue number8
DOIs
Publication statusPublished - 1998 Apr 15

Fingerprint

Spinal Nerve Roots
Somatosensory Evoked Potentials
Surgical Instruments
Theoretical Models
Wounds and Injuries
Radiculopathy
Spinal Cord
Orthopedic Procedures
Rabbits
Spinal Injuries
Sciatic Nerve
Hemostatics
Spinal Cord Injuries
Ligaments
Needles
Electrodes
Spine

All Science Journal Classification (ASJC) codes

  • Physiology
  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

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title = "Neuromonitoring of an experimental model of clip compression on the spinal nerve root to characterize acute nerve root injury",
abstract = "Objectives. To evaluate the sensitivity of an electromonitoring method in acute nerve root injury, and to determine a proposed criterion for irreversible electrophysiologic degradation. Study Design. Acute nerve root injury was induced by a clip compression model in rabbits, mimicking nerve root injury by a transpedicular screw. A common neuromonitoring technique, spinal somatosensory-evoked potential, was used to study the electrophysiologic change during the procedure. Summary of Background Data. With the advent of the transpedicular screw system, increased risk of injury to the spinal root because of the passage of screws is not unexpected. Although both an experimental model and a clinical application in intraoperative neuromonitoring of spinal cord function have been established, the value of neuromonitoring of an acute spinal root injury remains obscure. Several neurophysiologic surveillance techniques have been used successfully to monitor the potential injury to the spinal cord during orthopedic procedures around the spinal cord and spinal column. Spinal somatosensory- evoked potential, which has the advantages of high amplitude and quick recording time, is used to detect nerve root impairment during the insertion of transpedicular screws. Methods. Experimental acute nerve root injury was induced in rabbits by direct hemostatic clip compression on the nerve root (S1) during different time intervals. Spinal somatosensory-evoked potential elicited by stimulating the sciatic nerve and recorded from a needle electrode at the L6-L7 interspinous ligament was monitored immediately before and after compression. Results. Spinal somatosensory-evoked potential is sensitive enough to detect the compromise of a single nerve root and that a decrease in the amplitude is the most reliable and sensitive sign. With this model, there was a statistically significant correlation between the compression time and reduction of amplitude and delay of latency. The critical criterion for irreversible electrophysiologic change was an amplitude loss of more than 20{\%} and a delay in latency immediately after nerve root compression. Conclusions. It was concluded that spinal somatosensory-evoked potential can provide immediate feedback of nerve root injury and should be considered for use during the dynamic phase of transpedicular screw insertion.",
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Neuromonitoring of an experimental model of clip compression on the spinal nerve root to characterize acute nerve root injury. / Jou, I. Ming; Lai, Kuo-An.

In: Spine, Vol. 23, No. 8, 15.04.1998, p. 932-940.

Research output: Contribution to journalArticle

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AB - Objectives. To evaluate the sensitivity of an electromonitoring method in acute nerve root injury, and to determine a proposed criterion for irreversible electrophysiologic degradation. Study Design. Acute nerve root injury was induced by a clip compression model in rabbits, mimicking nerve root injury by a transpedicular screw. A common neuromonitoring technique, spinal somatosensory-evoked potential, was used to study the electrophysiologic change during the procedure. Summary of Background Data. With the advent of the transpedicular screw system, increased risk of injury to the spinal root because of the passage of screws is not unexpected. Although both an experimental model and a clinical application in intraoperative neuromonitoring of spinal cord function have been established, the value of neuromonitoring of an acute spinal root injury remains obscure. Several neurophysiologic surveillance techniques have been used successfully to monitor the potential injury to the spinal cord during orthopedic procedures around the spinal cord and spinal column. Spinal somatosensory- evoked potential, which has the advantages of high amplitude and quick recording time, is used to detect nerve root impairment during the insertion of transpedicular screws. Methods. Experimental acute nerve root injury was induced in rabbits by direct hemostatic clip compression on the nerve root (S1) during different time intervals. Spinal somatosensory-evoked potential elicited by stimulating the sciatic nerve and recorded from a needle electrode at the L6-L7 interspinous ligament was monitored immediately before and after compression. Results. Spinal somatosensory-evoked potential is sensitive enough to detect the compromise of a single nerve root and that a decrease in the amplitude is the most reliable and sensitive sign. With this model, there was a statistically significant correlation between the compression time and reduction of amplitude and delay of latency. The critical criterion for irreversible electrophysiologic change was an amplitude loss of more than 20% and a delay in latency immediately after nerve root compression. Conclusions. It was concluded that spinal somatosensory-evoked potential can provide immediate feedback of nerve root injury and should be considered for use during the dynamic phase of transpedicular screw insertion.

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