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Principles of Neurophysiological Assessment, Mapping, and Monitoring pp 135–145Cite as

Electromyography (EMG)

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Abstract

The recording of compound muscle action potentials (CMAPs) in response to spontaneous or electrically stimulated cranial nerve, spinal nerve, or ventral root activation is known as intraoperative electromyography (EMG). EMG is one of the most useful modalities for intraoperative monitoring (IOM). EMG is beneficial in monitoring neurological function in conjunction with sensory and motor evoked potentials during surgeries involving spinal manipulation and cranial nerve involvement.

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References

  1. Koht A, Sloan TB, Toleikis JR. Monitoring the nervous system for anesthesiologists and other health care professionals. New York: Springer; 2011.

    Google Scholar 

  2. Hilger JA. Facial nerve stimulator. Trans Am Acad Ophthalmol Otolaryngol. 1964;68:74–6. PubMed PMID: 14116425.

    CAS  PubMed  Google Scholar 

  3. Rand RW, Kurze TL. Facial nerve preservation by posterior fossa transmeatal microdissection in total removal of acoustic tumours. J Neurol Neurosurg Psychiatry. 1965;28:311–6. PubMed PMID: 14338120, Pubmed Central PMCID: 495910.

    Article  CAS  Google Scholar 

  4. Al-Mefty O, Holoubi A, Rifai A, Fox JL. Microsurgical removal of suprasellar meningiomas. Neurosurgery. 1985;16(3):364–72. PubMed PMID: 3982616.

    Article  CAS  Google Scholar 

  5. Møller AR. Intraoperative neurophysiological monitoring. New York: Springer; 2010.

    Google Scholar 

  6. Calancie B, Lebwohl N, Madsen P, Klose KJ. Intraoperative evoked EMG monitoring in an animal model. A new technique for evaluating pedicle screw placement. Spine (Phila Pa 1976). 1992;17(10):1229–35. PubMed PMID: 1440014.

    Article  CAS  Google Scholar 

  7. Calancie B, Madsen P, Lebwohl N. Stimulus-evoked EMG monitoring during transpedicular lumbosacral spine instrumentation. Initial clinical results. Spine (Phila Pa 1976). 1994;19(24):2780–6. PubMed PMID: 7899979.

    Article  CAS  Google Scholar 

  8. Husain AM. A practical approach to neurophysiologic intraoperative monitoring [electronic resource]. New York: Demos; 2008.

    Google Scholar 

  9. Krassioukov AV, Sarjeant R, Arkia H, Fehlings MG. Multimodality intraoperative monitoring during complex lumbosacral procedures: indications, techniques, and long-term follow-up review of 61 consecutive cases. J Neurosurg Spine. 2004;1(3):243–53. PubMed PMID: 15478361.

    Article  Google Scholar 

  10. Balzer JR, Rose RD, Welch WC, Sclabassi RJ. Simultaneous somatosensory evoked potential and electromyographic recordings during lumbosacral decompression and instrumentation. Neurosurgery. 1998;42(6):1318–24. Discussion 24–5, PubMed PMID: 9632191.

    Article  CAS  Google Scholar 

  11. Nichols GS, Manafov E. Utility of electromyography for nerve root monitoring during spinal surgery. J Clin Neurophysiol. 2012;29(2):140–8. PubMed PMID: 22469677.

    Article  Google Scholar 

  12. Santiago-Perez S, Nevado-Estevez R, Aguirre-Arribas J, Perez-Conde MC. Neurophysiological monitoring of lumbosacral spinal roots during spinal surgery: continuous intraoperative electromyography (EMG). Electromyogr Clin Neurophysiol. 2007;47(7–8):361–7. PubMed PMID: 18051630.

    CAS  PubMed  Google Scholar 

  13. Welch WC, Rose RD, Balzer JR, Jacobs GB. Evaluation with evoked and spontaneous electromyography during lumbar instrumentation: a prospective study. J Neurosurg. 1997;87(3):397–402. PubMed PMID: 9285605.

    Article  CAS  Google Scholar 

  14. Prass RL, Luders H. Acoustic (loudspeaker) facial electromyographic monitoring: Part 1. Evoked electromyographic activity during acoustic neuroma resection. Neurosurgery. 1986;19(3):392–400. PubMed PMID: 3762886.

    Article  CAS  Google Scholar 

  15. Schekutiev G, Schmid U. Coaxial insulated bipolar electrode for monopolar and bipolar mapping of neural tissue: technical note with emphasis on the principles of intra-operative stimulation. Acta Neurochir. 1996;138(4):470–474:0942-0940.

    Article  CAS  Google Scholar 

  16. Holland NR, Lukaczyk TA, Riley LH 3rd, Kostuik JP. Higher electrical stimulus intensities are required to activate chronically compressed nerve roots. Implications for intraoperative electromyographic pedicle screw testing. Spine (Phila Pa 1976). 1998;23(2):224–7. PubMed PMID: 9474730.

    Article  CAS  Google Scholar 

  17. Mandpe AH, Mikulec A, Jackler RK, Pitts LH, Yingling CD. Comparison of response amplitude versus stimulation threshold in predicting early postoperative facial nerve function after acoustic neuroma resection. Am J Otol. 1998;19(1):112–7. PubMed PMID: 9455959.

    CAS  PubMed  Google Scholar 

  18. Neff BA, Ting J, Dickinson SL, Welling DB. Facial nerve monitoring parameters as a predictor of postoperative facial nerve outcomes after vestibular schwannoma resection. Otol Neurotol. 2005;26(4):728–32. PubMed PMID: 16015176.

    Article  Google Scholar 

  19. Uribe J, Vale F, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine. 2010;35(265):368–74.

    Article  Google Scholar 

  20. Kim YJ, Lenke LG, Bridwell KH, Cho YS, Riew KD. Free hand pedicle screw placement in the thoracic spine: is it safe? Spine (Phila Pa 1976). 2004;29(3):333–42. Discussion 42, PubMed PMID: 14752359.

    Article  Google Scholar 

  21. Laine T, Lund T, Ylikoski M, Lohikoski J, Schlenzka D. Accuracy of pedicle screw insertion with and without computer assistance: a randomised controlled clinical study in 100 consecutive patients. Eur Spine J. 2000;9(3):235–40. PubMed PMID: 10905443, Pubmed Central PMCID: 3611394.

    Article  CAS  Google Scholar 

  22. Alemo S, Sayadipour A. Role of intraoperative neurophysiologic monitoring in lumbosacral spine fusion and instrumentation: a retrospective study. World Neurosurg. 2010;73(1):72–6. Discussion e7, PubMed PMID: 20452872.

    Article  Google Scholar 

  23. Darden BV 2nd, Wood KE, Hatley MK, Owen JH, Kostuik J. Evaluation of pedicle screw insertion monitored by intraoperative evoked electromyography. J Spinal Disord. 1996;9(1):8–16. PubMed PMID: 8727451.

    Article  Google Scholar 

  24. Djurasovic M, Dimar JR 2nd, Glassman SD, Edmonds HL, Carreon LY. A prospective analysis of intraoperative electromyographic monitoring of posterior cervical screw fixation. J Spinal Disord Tech. 2005;18(6):515–8. PubMed PMID: 16306841, Epub 2005/11/25.

    Article  Google Scholar 

  25. Holdefer RN, Heffez DS, Cohen BA. Utility of evoked EMG monitoring to improve bone screw placements in the cervical spine. J Spinal Disord Tech. 2013;26(5):E163–9. PubMed PMID: 23429315.

    Article  Google Scholar 

  26. Parker SL, Amin AG, Farber SH, McGirt MJ, Sciubba DM, Wolinsky JP, et al. Ability of electromyographic monitoring to determine the presence of malpositioned pedicle screws in the lumbosacral spine: analysis of 2450 consecutively placed screws. J Neurosurg Spine. 2011;15(2):130–5. PubMed PMID: 21529126.

    Article  Google Scholar 

  27. Patil S, Lindley EM, Burger EL, Yoshihara H, Patel VV. Pedicle screw placement with O-arm and stealth navigation. Orthopedics. 2012;35(1):e61–5. PubMed PMID: 22229616.

    Article  Google Scholar 

  28. Larson AN, Santos ER, Polly DW Jr, Ledonio CG, Sembrano JN, Mielke CH, et al. Pediatric pedicle screw placement using intraoperative computed tomography and 3-dimensional image-guided navigation. Spine (Phila Pa 1976). 2012;37(3):E188–94. PubMed PMID: 21738101.

    Article  Google Scholar 

  29. Kim YJ, Lenke LG, Cheh G, Riew KD. Evaluation of pedicle screw placement in the deformed spine using intraoperative plain radiographs: a comparison with computerized tomography. Spine (Phila Pa 1976). 2005;30(18):2084–8. PubMed PMID: 16166900.

    Article  Google Scholar 

  30. Bindal RK, Ghosh S. Intraoperative electromyography monitoring in minimally invasive transforaminal lumbar interbody fusion. J Neurosurg Spine. 2007;6(2):126–32. PubMed PMID: 17330579.

    Article  Google Scholar 

  31. de Blas G, Barrios C, Regidor I, Montes E, Burgos J, Piza-Vallespir G, et al. Safe pedicle screw placement in thoracic scoliotic curves using t-EMG: stimulation threshold variability at concavity and convexity in apex segments. Spine (Phila Pa 1976). 2012;37(6):E387–95. PubMed PMID: 22024903.

    Article  Google Scholar 

  32. Min WK, Lee HJ, Jeong WJ, Oh CW, Bae JS, Cho HS, et al. Reliability of triggered EMG for prediction of safety during pedicle screw placement in adolescent idiopathic scoliosis surgery. Asian Spine J. 2011;5(1):51–8. PubMed PMID: 21386946, Pubmed Central PMCID: 3047898.

    Article  Google Scholar 

  33. Raynor BL, Lenke LG, Bridwell KH, Taylor BA, Padberg AM. Correlation between low triggered electromyographic thresholds and lumbar pedicle screw malposition: analysis of 4857 screws. Spine (Phila Pa 1976). 2007;32(24):2673–8. PubMed PMID: 18007243.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Neuromonitoring Associates, Las Vegas, NV, USA

    Aaron J. Beverwyk

  2. University Medical Center New Orleans, Department of Anesthesiology, New Orleans, LA, USA

    Kenneth Mancuso

  3. Emory University School of Medicine, Department of Anesthesiology, Division of Critical Care, Atlanta, GA, USA

    Amit Prabhakar

  4. Department of Anesthesiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Jonathan Lissauer

  5. Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, Shreveport, LA, USA

    Alan David Kaye

  6. LSU School of Medicine, Department of Anesthesiology, New Orleans, LA, USA

    Alan David Kaye

  7. Tulane School of Medicine, New Orleans, LA, USA

    Alan David Kaye

  8. Department of Anesthesiology, Louisiana State University School of Medicine, Tulane University School of Medicine, New Orleans, LA, USA

    Scott Francis Davis

Authors
  1. Aaron J. Beverwyk
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  2. Kenneth Mancuso
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  3. Amit Prabhakar
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  4. Jonathan Lissauer
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  5. Alan David Kaye
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  6. Scott Francis Davis
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, Tulane University School of Medicine, New Orleans, LA, USA

    Scott Francis Davis

  2. Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU School of Medicine, Shreveport, LA, USA

    Alan David Kaye

Review Questions

Review Questions

  1. 1.

    What are the pathological EMG firing patterns commonly seen in intraoperative EMG in the order of severity?

  2. 2.

    What is a motor unit and how do motor units differ across muscle groups?

  3. 3.

    What are possible explanations of baseline muscle activity recorded prior to surgical manipulation?

  4. 4.

    How would you dialogue with a surgeon who stimulated pedicle screws bilaterally at L4 and L5 and recorded thresholds of between 6 and 8 mA?

  5. 5.

    What are the advantages of multimodality SSEP and EMG monitoring. What can each modality tell you?

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Beverwyk, A.J., Mancuso, K., Prabhakar, A., Lissauer, J., Kaye, A.D., Davis, S.F. (2020). Electromyography (EMG). In: Davis, S., Kaye, A. (eds) Principles of Neurophysiological Assessment, Mapping, and Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-22400-4_8

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  • DOI: https://doi.org/10.1007/978-3-030-22400-4_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-22399-1

  • Online ISBN: 978-3-030-22400-4

  • eBook Packages: MedicineMedicine (R0)

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