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Neurophysiological Monitoring During Placement of Spinal Instrumentation

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Essentials of Spinal Stabilization

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Abstract

Neurophysiologic intraoperative monitoring improves postoperative outcomes by alerting the surgeon to increased risk of neurologic injury. Neurodiagnostic monitoring techniques for spine surgery include somatosensory evoked potentials (SEP), transcranial electrical motor evoked potentials (MEP), and electromyography (EMG).

Monitoring teams understand tactics for obtaining quality recordings and raising alarms when change progresses beyond recognized limits of normal variation. Surgeons and anesthesiologists respond to monitoring alerts with a variety of actions, some as straightforward as raising blood pressure or adjusting retractors. In experienced hands, neurophysiologic intraoperative monitoring substantially reduces postoperative deficits, e.g., 60% reduction in risk of paraplegia and paraparesis.

Monitoring is set up by a technologist in the operating room and supervised by an experienced clinical neurophysiologist. In straightforward cases, the monitoring neurophysiologist may remotely monitor from outside the operating room.

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Author information

Authors and Affiliations

  1. Department of Neurology, David Geffen School of Medicine at UCLA, Reed Bldg, room 1190, 710 Westwood Plaza, Los Angeles, CA, 90095, USA

    Marc R. Nuwer MD, PhD

  2. Clinical Neurophysiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA

    Marc R. Nuwer MD, PhD

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  1. Marc R. Nuwer MD, PhD
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Correspondence to Marc R. Nuwer MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery and Orthopaedics, David Geffen UCLA School of Medicine, Los Angeles, California, USA

    Langston T. Holly

  2. Department of Orthopedics and Rehabilitation, University of Wisconsin UWMF, Madison, Wisconsin, USA

    Paul A. Anderson

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Nuwer, M.R. (2017). Neurophysiological Monitoring During Placement of Spinal Instrumentation. In: Holly, L., Anderson, P. (eds) Essentials of Spinal Stabilization . Springer, Cham. https://doi.org/10.1007/978-3-319-59713-3_38

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  • DOI: https://doi.org/10.1007/978-3-319-59713-3_38

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-59712-6

  • Online ISBN: 978-3-319-59713-3

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