Journal of Clinical Monitoring and Computing

, Volume 27, Issue 1, pp 93–96 | Cite as

Does intraoperative neurophysiological monitoring have predictive value for functional recovery following spinal cord injury? A case report

  • Jason C. Eck
  • Christopher J. Martin
  • Anthony Lapinsky
  • Patrick J. Connolly
  • Christian DiPaola
Brief Report

Abstract

To present a case report of a patient with an ASIA B spinal cord injury with partially intact baseline IONM who made a complete functional recovery postoperatively. A thirty-three year old male presented after a motor vehicle accident. Imaging studies revealed a C4–C5 bilateral facet dislocation. On presentation the patient had 4/5 strength in bilateral biceps and wrist extensors, 3/5 strength in bilateral triceps, and 0/5 strength in the finger flexors, intrinsics and all lower extremity muscles. Motor level was C7. Sensation was grossly intact to light touch throughout all extremities, intact to pinprick from C2 to T7, and absent to pinprick caudal to T7. Rectal tone and contraction were absent. After attempts at closed reduction failed the patient underwent an open reduction and posterior C4–C5 fusion. Intraoperative neurophysiologic monitoring (IONM) revealed the presence of baseline responses to the posterior tibial nerve using somatosensory evoked potentials and to the right abductor hallucis using transcranial motor evoked potentials. At the 6 weeks postoperative visit the patient had full 5/5 motor strength to all muscles except the left deltoid that was 4/5 due to a rotator cuff injury. This case illustrates a potential prognostic value of IONM. Despite lack of clinical motor function at the time of surgery, IONM was able to illicit a motor response in the right lower extremity. Further prospective studies are needed for further investigation.

Keywords

Spinal Cord Injury Rotator Cuff Spinal Cord Injury Patient American Spinal Injury Association Acute Spinal Cord Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

Each of the authors declares that he has no financial relationship with the organization that sponsored the study.

Ethical Standards

The experiments comply with the current laws of the United States of America.

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Jason C. Eck
    • 1
  • Christopher J. Martin
    • 2
  • Anthony Lapinsky
    • 1
  • Patrick J. Connolly
    • 1
  • Christian DiPaola
    • 1
  1. 1.Department of Orthopedic SurgeryUniversity of MassachusettsWorcesterUSA
  2. 2.Safe Passage NeuromonitoringRyeUSA

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