Skip to main content
SpringerLink
Log in

Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials

  • Original Research
  • Published:
Journal of Clinical Monitoring and Computing Aims and scope Submit manuscript

Abstract

We have previously investigated electromyographic (EMG) and transcranial motor evoked potential (MEP) abnormalities after mechanical spinal cord injury. We now report thermally generated porcine spinal cord injury, characterized by spinal cord generated hindlimb EMG injury activity and spinal cord motor conduction block (MEP loss). Electrocautery (EC) was delivered to thoracic level dural root sleeves within 6–8 mm of the spinal cord (n = 6). Temperature recordings were made near the spinal cord. EMG and MEP were recorded by multiple gluteobiceps intramuscular electrodes before, during, and after EC. Duration of EC was titrated to an end-point of spinal motor conduction block (MEP loss). In 5/6 roots, ipsilateral EMG injury activity was induced by EC. In 4/5 roots, EMG injury activity was identified before MEP loss. In all roots, a minimum of 20 s EC and a temperature maximum of at least 57 °C at the dural root sleeve were required to induce MEP loss. Unexpectedly, conduction block was preceded by an enhanced MEP in 4/6 trials. EMG injury activity, preceding MEP loss, can be seen during near spinal cord EC. Depolarization and facilitation of lumbar motor neurons by thermally excited descending spinal tracts likely explains both hindlimb EMG and an enhanced MEP signal (seen before conduction block) respectively. A thermal mechanism may play a role in some unexplained MEP losses during intraoperative monitoring. EMG recordings might help to detect abnormal discharges and forewarn the monitorist during both mechanical and thermal injury to the spinal cord.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Aydin MD, Dane S, Gundogdu C, Gursan N. Neurodegenerative effects of monopolar electrocauterization on spinal ganglia in lumbar disc surgery. Acta Neurochir. 2004;146:1125–9.

    Article  PubMed  CAS  Google Scholar 

  2. Bunch TJ, Bruce GK, Mahapatra S, Johnson SB, Miller DV, Sarabanda AV, et al. Mechanisms of phrenic nerve injury during radiofrequency ablation at the pulmonary vein orifice. J Cardiovasc Electr. 2005;16:1318–25.

    Article  Google Scholar 

  3. McCarty EC, Warren RF, Deng XH, Craig EV, Potter H. Temperature along the axillary nerve during radiofrequency-induced thermal capsular shrinkage. Am J Sports Med. 2004;32:909–14.

    Article  PubMed  Google Scholar 

  4. Skinner SA, Nagib M, Bergman TA, Maxwell RE, Msangi G. The initial use of free-running electromyography to detect early motor tract injury during resection of intramedullary spinal cord lesions. Neurosurgery. 2005;56:299–314.

    Article  PubMed  Google Scholar 

  5. Skinner SA, Transfeldt EE, Mehbod AA, Mullan JC, Perra JH. Electromyography detects mechanically-induced suprasegmental spinal motor tract injury: review of decompression at spinal cord level. Clin Neurophysiol. 2009;120:754–64.

    Article  PubMed  Google Scholar 

  6. Skinner SA, Transfeldt EE. Electromyography in the detection of mechanically induced spinal motor tract injury: observation in diverse porcine models. J Neurosurg Spine. 2009;11:369–74.

    Article  PubMed  Google Scholar 

  7. Lips J, de Haan P, de Jager SW, Vanicky I, Jacobs MJ, Kalkman CJ. The role of transcranial motor evoked potentials in predicting neurologic and histopathologic outcome after experimental spinal cord ischemia. Anesthesiology. 2002;97:183–91.

    Article  PubMed  Google Scholar 

  8. Langeloo DD, Lelivelt A, Louis Journe′e H, Slappendel R, de Kleuver M. Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine. 2003;28:1043–50.

    PubMed  Google Scholar 

  9. Nair DR, Brooks JR. Cerebellopontine angle surgery: tumor. In: Husain AM, editor. A practical approach to neurophysiologic intraoperative monitoring. New York: Demos; 2008. p. 217.

    Google Scholar 

  10. Wiedermayer H, Fauser B, Sandalcioglu IE, Schafer H, Stolke D. The impact of neurophysiological intraoperative monitoring on surgical decisions: a critical analysis of 423 cases. J Neurosurg. 2002;96:255–62.

    Article  Google Scholar 

  11. Bier M, Chen W, Bodnar E, Lee RC. Biophysical injury mechanisms associated with lightning injury. Neurorehabilitation. 2005;20:53–62.

    PubMed  Google Scholar 

  12. Bingham H. Electrical burns. Clin Plast Surg. 1986;13:75–85.

    PubMed  CAS  Google Scholar 

  13. Ryan CM. Neurological manifestations of electrical trauma. In: 26th Annual international conference of the IEEE EMBS. San Francisco, CA, USA; 2004. p. 5437–9.

  14. Thaventhiran J, O’Leary MJ, Coakley JH, Rose M, Nagendran K, Greenwood R. Pathogenesis and recovery of tetraplegia after electrical injury. J Neurol Neurosurg Psychiatry. 2001;71:535–7.

    Article  PubMed  CAS  Google Scholar 

  15. Memon MA. Surgical diathermy. Br J Hosp Med. 1994;52:403–8.

    PubMed  CAS  Google Scholar 

  16. Lee RC, Gaylor DC, Bhatt D, Israel DA. Role of cell membrane rupture in the pathogenesis of electrical trauma. J Surg Res. 1988;44:709–19.

    Article  PubMed  CAS  Google Scholar 

  17. Lee RC, Kolodney MS. Electrical injury mechanisms: dynamics of the thermal response. Plast Reconstr Surg. 1987;80:663–71.

    Article  PubMed  CAS  Google Scholar 

  18. Xu D, Pollock M. Experimental nerve thermal injury. Brain. 1994;117:375–84.

    Article  PubMed  Google Scholar 

  19. Konno S, Olmarker K, Byrod G, Nordborg C, Stromqvist B, Rydevik B. Acute thermal nerve root injury. Eur Spine J. 1994;3:299–302.

    Article  PubMed  CAS  Google Scholar 

  20. Foerster O. Symptomatologie der erkrankungen des ruckenmarks und seiner wurzeln. In: Bumke O, Foerster O, editors. Handbook of neurology. Berlin: Springer; 1936. Vol 5: p. 83.

  21. Westmoreland BF, Benarroch EE, Daube JR, Readan TJ, Sandok BA. Medical neurosciences: an approach to anatomy, pathology, and physiology but systems and levels. 3rd ed. New York: Little Brown and Company; 1994.

    Google Scholar 

  22. Pappas CT, Gibson AR, Sonntag VK. Decussation of hind-limb and fore-limb fibers in the monkey corticospinal tract: relevance to cruciate paralysis. J Neurosurg. 1991;75:935–40.

    Article  PubMed  CAS  Google Scholar 

  23. Levi A, Tator CH, Bunge P. Clinical syndromes associated with disproportionate weakness of the upper versus lower extremities after cervical spinal cord injury. Neurosurgery. 1996;38:179–85.

    Article  PubMed  CAS  Google Scholar 

  24. Julian FJ, Goldman DE. The effects of mechanical stimulation on some electrical properties of axons. J Gen Physiol. 1962;46:297–313.

    Article  PubMed  CAS  Google Scholar 

  25. Galbraith JA, Thibault LE, Matteson DR. Mechanical and electrical responses of the squid giant axon to simple elongation. J Biomech Eng. 1993;115:13–22.

    Article  PubMed  CAS  Google Scholar 

  26. Ganot G, Wong BS, Binstock L, Ehrenstein G. Reversal potentials corresponding to mechanical stimulation and leakage current in Myxicola giant axons. Biochim Biophys Acta. 1981;649:487–91.

    Article  PubMed  CAS  Google Scholar 

  27. Honmou O, Young W. Traumatic injury of spinal axon. In: Waxmann SG, Kocsis JD, Stys PK, editors. The axon: structure, function, and pathophysiology. Oxford: Oxford University Press; 1995. p. 480–503.

    Google Scholar 

  28. Sakatani K, Hatabu Y, Young W, Gruner JA, Iizuka H, Taniguchi K. New sensitive methods for detecting acute axonal dysfunction after experimental spinal cord and root compression injury. In: Shimoji K, Kurokawa T, Tamaki T, Willis Jr WD, editors. Spinal cord monitoring and electrodiagnosis. New York: Springer; 1991. p. 141–51.

    Chapter  Google Scholar 

  29. Cravalho EG, Toner M, Gaylor DC, Lee RC. Response of cells to supraphysiological temperatures: experimental measurements and kinetic models. In: Lee RC, Cravalho EG, Burke JF, editors. Electrical trauma; the pathophysiology, manifestations, and clinical management. New York: Cambridge University Press; 1992.

    Google Scholar 

  30. Tropea BI, Lee RC. Thermal injury kinetics in electrical trauma. J Biomech Eng. 1992;114:241–50.

    Article  PubMed  CAS  Google Scholar 

  31. Journee HL, Polak HE, de Kleuver M, Langeloo DD, Postma A. Improved neuromonitoring during Spinal Surgery using double-train transcranial electrical stimulation. Med Biol Eng Comput. 2004;42:110–3.

    Article  PubMed  CAS  Google Scholar 

  32. Skinner SA, Chiri C, Wroblewski J, Transfeldt EE. Enhancement of the bulbocavernosus reflex during intraoperative neurophysiological monitoring through the use of double train stimulation: a pilot study. J Clin Monit Comput. 2006;21:31–40.

    Article  PubMed  Google Scholar 

  33. Cheh G, Lenke LG, Padberg AN, Yongjung JK, Daubs MD, Kuhns C, et al. Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do? Spine. 2008;33:1093–9.

    Article  PubMed  Google Scholar 

  34. Donzelli J, Leonetti JP, Wurster RD, Lee JM, Young MR. Neuroprotection due to irrigation during bipolar cautery. Arch Otolaryngol Head Neck Surg. 2000;126:149–53.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Joyce Wiberg REEG, Angie Talbot, and Michelle Vrieze, CNIM (neuromonitoring technologist) for their capable assistance. They would also like to thank the following for assistance with manuscript preparation: Deanna Aleksandrowicz, Larry Sobaskie, and Carol Garner (medical illustrator).

Conflict of interest

Dr. Skinner and Dr. Transfeldt are royalty bearing for patent through Medtronic Sofamor-Danek. Dr. Mehbod is a consultant for Medtronic Sofamor-Danek. Dr. Rippe, Dr. Wu, Dr. Hsu, and Dr. Erkan have no financial interests to disclose.

Author information

Authors and Affiliations

  1. Neurophysiology Department, Abbott Northwestern Hospital, Minneapolis, MN, USA

    Stanley A. Skinner & David M. Rippe

  2. Twin Cities Spine Center, Abbott Northwestern Hospital, Minneapolis, MN, USA

    Brian Hsu, Ensor E. Transfeldt, Amir A. Mehbod & Serkan Erkan

  3. Foundation for the Advancement of Spine Knowledge, Minneapolis, MN, USA

    Chunhui Wu

Authors
  1. Stanley A. Skinner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ensor E. Transfeldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amir A. Mehbod
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David M. Rippe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Chunhui Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Serkan Erkan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stanley A. Skinner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Skinner, S.A., Hsu, B., Transfeldt, E.E. et al. Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials. J Clin Monit Comput 27, 195–201 (2013). https://doi.org/10.1007/s10877-012-9417-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10877-012-9417-2

Keywords

Search

Navigation