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.
References
Maynard FM Jr, Bracken MB, Creasey G, et al. International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord. 1997;35:266–74.
Harrop JS, Naroji S, Maltenfort MG, et al. Neurologic improvement after thoracic, thoracolumbar, and lumbar spinal cord (conus medullaris) injuries. Spine (Phila Pa 1976). 2011;36:21–5.
Al-Habib AF, Attabib N, Ball J, Bajammal S, Casha S, Hurlbert RJ. Clinical predictors of recovery after blunt spinal cord trauma: systematic review. J Neurotrauma. 2011;28:1431–43.
Fisher CG, Noonan VK, Smith DE, Wing PC, Dvorak MF, Kwon B. Motor recovery, functional status, and health-related quality of life in patients with complete spinal cord injuries. Spine. 2005;30:2200–7.
Bozzo A, Goulet B, Marcoux J, Pelletier J, Radhakrishna M. The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma. 2011;28:1401.
Fehlings MG, Cadotte DW, Fehlings LN. A series of systematic reviews on the treatment of acute spinal cord injury: a foundation for best medical practice. J Neurotrauma. 2011;28:1329–33.
Furlan JC, Noonan V, Cadotte DW, Fehlings MG. Timing of decompressive surgery of spinal cord after traumatic spinal cord injury: an evidence-based examination of pre-clinical and clinical studies. J Neurotrauma. 2011;28:1371–99.
Furlan JC, Noonan V, Singh A, Fehlings MG. Assessment of disability in patients with acute traumatic spinal cord injury: a systematic review of the literature. J Neurotrauma. 2011;28:1413–30.
Parent S, Barchi S, LeBreton M, Casha S, Fehlings MG. The impact of specialized centers of care for spinal cord injury on length of stay, complications, and mortality: a systematic review of the literature. J Neurotrauma. 2011;28:1363–70.
Chabot R, York DH, Watts C, Waugh WA. Somatosensory evoked potentials evaluated in normal subjects and spinal cord-injured patients. J Neurosurg. 1985;63:544–51.
Spiess M, Schubert M, Kliesch U, Halder P. Evolution of tibial SSEP after traumatic spinal cord injury: baseline for clinical trials. Clin Neurophysiol. 2008;119:1051–61.
Jacobs SR, Yeaney NK, Herbison GJ, Ditunno JF Jr. Future ambulation prognosis as predicted by somatosensory evoked potentials in motor complete and incomplete quadriplegia. Arch Phys Med Rehabil. 1995;76:635–41.
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Each of the authors declares that he has no financial relationship with the organization that sponsored the study.
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Eck, J.C., Martin, C.J., Lapinsky, A. et al. Does intraoperative neurophysiological monitoring have predictive value for functional recovery following spinal cord injury? A case report. J Clin Monit Comput 27, 93–96 (2013). https://doi.org/10.1007/s10877-012-9395-4
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DOI: https://doi.org/10.1007/s10877-012-9395-4