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Optimizing the methodology for saphenous nerve somatosensory evoked potentials for monitoring upper lumbar roots and femoral nerve during lumbar spine surgery: technical note

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Abstract

The demand for intraoperative monitoring (IOM) of lumbar spine surgeries has escalated to accommodate more challenging surgical approaches to prevent perioperative neurologic deficits. Identifying impending injury of individual lumbar roots can be done by assessing free-running EMG and by monitoring the integrity of sensory and motor fibers within the roots by eliciting somatosensory (SEP), and motor evoked potentials. However, the common nerves for eliciting lower limb SEP do not monitor the entire lumbar plexus, excluding fibers from L1 to L4 roots. We aimed to technically optimize the methodology for saphenous nerve SEP (Sap-SEP) proposed for monitoring upper lumbar roots in the operating room. In the first group, the saphenous nerve was consecutively stimulated in two different locations: proximal in the thigh and distal close to the tibia. In the second group, three different recording derivations (10–20 International system) to distal saphenous stimulation were tested. Distal stimulation yielded a higher Sap-SEP amplitude (mean ± SD) than proximal: 1.36 ± 0.9 µV versus 0.62 ± 0.6 µV, (p < 0.0001). Distal stimulation evoked either higher (73%) or similar (12%) Sap-SEP amplitude compared to proximal in most of the nerves. The recording derivation CPz–cCP showed the highest amplitude in 65% of the nerves, followed by CPz–Fz (24%). Distal stimulation for Sap-SEP has advantages over proximal stimulation, including simplicity, lack of movement and higher amplitude responses. The use of two derivations (CPz–cCP, CPz–Fz) optimizes Sap-SEP recording.

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Authors and Affiliations

  1. Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, 1000, 10th Avenue, New York, NY, USA

    M. Ángeles Sánchez Roldán, Francisco Mora Granizo, Victoria Oflidis, Maria J. Téllez & Sedat Ulkatan

  2. Department of Neurosurgery, Mount Sinai West Hospital, New York, NY, USA

    Konstantinos Margetis

  3. Emeritus Professor Department of Neurology, University of Iowa Health Care, Iowa City, IA, USA

    Jun Kimura

Authors
  1. M. Ángeles Sánchez Roldán
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  2. Francisco Mora Granizo
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  3. Victoria Oflidis
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  4. Konstantinos Margetis
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  5. Maria J. Téllez
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  6. Sedat Ulkatan
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  7. Jun Kimura
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Correspondence to Sedat Ulkatan.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study. This study was approved by the IRB at Mount Sinai System (IRB # 18-01277).

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Sánchez Roldán, M.Á., Mora Granizo, F., Oflidis, V. et al. Optimizing the methodology for saphenous nerve somatosensory evoked potentials for monitoring upper lumbar roots and femoral nerve during lumbar spine surgery: technical note. J Clin Monit Comput 36, 1079–1085 (2022). https://doi.org/10.1007/s10877-021-00737-6

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  • DOI: https://doi.org/10.1007/s10877-021-00737-6

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