Huge thoracolumbar extradural arachnoid cyst excised by recapping T-saw laminoplasty

Background context

Spinal extradural arachnoid cysts are rare expanding lesions in the spinal canal. Total removal of the cyst and repair of the dural defect is the primary treatment for symptomatic spinal extradural arachnoid cysts.

Purpose

To report the usefulness of recapping T-saw laminoplasty in treating huge extradural arachnoid cyst.

Study design

Case report.

Methods

We report the case of a 43-year-old man who presented with a 2-year history of progressive muscle weakness and numbness of the lower extremities. Magnetic resonance imaging (MRI) showed a huge extradural arachnoid cyst at the T12–L3 level extending into bilateral neural foramina and severe posterior compression of the spinal cord and cauda equina.

Results

The patient underwent total resection of the cyst and closure of the communication. En bloc recapping T-saw laminoplasty of T12–L2 including the T12–L1 and L1–L2 facet joints was performed to obtain extensive exposure and preserve posterior stability. Postoperatively, the patient achieved complete recovery of neurologic functions. Follow-up MRI demonstrated no recurrence of the cyst. Bone union after laminoplasty was obtained within 6 months.

Conclusion

Total resection of the cyst and closure of the communication is curative for this rare lesion. Recapping T-saw laminoplasty provides extensive exposure for removal of a large cyst while allowing complete preservation of the posterior spinal elements.     

Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up

Background context

Anterior cervical discectomy and fusion using cervical plates has been seen as effective at relieving cervical radiculopathy and myelopathy symptoms. Although it is commonly used, subsequent disc degeneration at levels adjacent to the fusion remains an important problem. However, data on the frequency, impact, and predisposing factors for this pathology are still rare.

Purpose

To evaluate the incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies after anterior cervical discectomy and fusion using cervical plates and to analyze the efficacy of this surgical method over the long term, after a minimum follow-up period of 10 years.

Study design

Retrospective clinical study.

Patient sample

Our study was a retrospective analysis of 177 patients who underwent anterior cervical discectomy and fusion using cervical plates, with follow-up periods of at least 10 years (mean 16.2 years).

Outcome measures

Radiographic adjacent-segment pathology using plain radiographs and clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates.

Methods

We defined a new grading system of plain radiographic evidence of degenerative changes in adjacent discs after anterior cervical discectomy and fusion using cervical plates; Grade 0 is considered normal, and Grade V consists the presence of posterior osteophytes and a decrease in disc height to less than 50% of normal. The incidence, predisposing factors, and impact of radiographic and clinical adjacent-segment pathologies were analyzed according to etiologies, number of fused segments, and plate-to-disc distance.

Results

Radiographic and clinical adjacent-segment pathologies were found in 92.1% and 19.2%, respectively, of patients. By etiology, clinical adjacent-segment pathology was observed in 13.5% of patients who had sustained trauma, 12.7% of those with disc herniation, and 33.3% of those with spondylosis. By number of fused segments, clinical adjacent-segment pathology was found in 13.2% of patients who underwent single-level fusion and in 32.1% of those who underwent multilevel fusion surgeries. Patients with a plate-to-disc distance of less than 5 mm, who had spondylosis, or who underwent multilevel fusion had a higher incidence of clinical adjacent-segment pathology after anterior cervical discectomy and fusion using cervical plates than other groups did (p<.05). Of all patients, only 6.8% needed follow-up surgery.

Conclusions

We found that over the long term, at a minimum follow-up point of 10 years, a plate-to-disc distance of less than 5 mm, having spondylosis, and undergoing multilevel fusion were predisposing factors for the occurrence of clinical adjacent-segment pathology. Nevertheless, the incidence of clinical findings of adjacent-segment pathology was much lower than the incidence of radiographic findings. Also, the rate of follow-up surgery was low. Therefore, anterior cervical discectomy and fusion using cervical plates can be considered a safe and effective procedure.     

Intraosseous ganglion cyst within the L4 lamina causing spinal stenosis

Background context

There are rare reports of intraosseous ganglion cysts in the cervical spine. However, to our knowledge, there are no previous reports of these cysts occurring in the lumbar spine.

Purpose

To report a case of symptomatic lumbar spinal stenosis caused by an intraosseous ganglion cyst of the L4 lamina that communicated with the spinal canal.

Study design

Case report.

Methods

An 86-year-old woman was referred to our spine service for a 2-year history of anterior thigh and leg pain. Magnetic resonance imaging revealed a benign-appearing intraosseous cyst in the left L4 lamina communicating with a posterior epidural cyst at L4–L5 causing marked spinal stenosis. The patient was treated successfully with a laminectomy and resection.

Results

The patient underwent partial laminectomies of L4 and L5 preserving the interspinous ligaments between L5–S1 and L3–L4. The cyst was removed en bloc without violation of the cyst wall. Histopathologic examination revealed focal myxoid changes without a cellular lining of the cyst wall, confirming the diagnosis of intraosseous ganglion cyst.

Conclusions

This is the first report to describe an intraosseous ganglion cyst occurring in the lumbar spine. Although spinal stenosis is commonly a result of degenerative joint or disc disease, it occasionally may result from more obscure causes. This case illustrates a patient with an intraosseous ganglion cyst within the spinal lamina resulting in spinal stenosis, treated successfully with a laminectomy and resection.     

Anterior cervical intradural arachnoid cyst,a rare cause of spinal cord compression: a case report with video systematic literature review

Purpose

Mostly seen at the thoracic level, arachnoid cysts are a very rare cause of cervical spinal cord compression. Generally treated by laminectomy and cyst fenestration, this approach does not allow removing the cyst in its entirety without manipulating the weakened spinal cord. The aim of this report is to present the case of a cervical intradural arachnoid cyst surgically removed by an anterior approach with corporectomy.

Methods

Here is the case of an 18-year-old amateur boxer presenting with a voluminous cervical intradural anterior arachnoid cyst, extending from C2 to C5. Symptoms were cervical pain, quadriparesis, and clumsiness of both arms which had appeared just after a traffic accident. An anterior approach was chosen, through a C5 corporectomy.

Results

The patient totally recovered from his sensitive symptoms at discharge and from his motor symptoms 6 weeks later. Early as well as 3-years post-operatively, MRI confirmed expansion of the spinal cord without any centro-medullar signal. The patient remained asymptomatic 3 years after surgery. Since the first report in 1974, 16 cases of symptomatic cervical intradural arachnoid cysts were treated via a posterior approach, one by MRI-guided biopsy, and one was re-operated on through an anterior approach. For 14 patients, their conditions had improved, while one died of pneumonia, one presented a condition worsened, and one had a stable neurological status.

Conclusion

Using an anterior approach is a safe procedure that allows resection of a cervical arachnoid cyst without any manipulation of the weakened spinal cord, while giving the best possible view.

     

Multiple primary intramedullary ependymomas: a case report and review of the literature

Background context

Intramedullary ependymomas constitute the most frequent type of intramedullary tumor. In patients with neurofibromatosis type 2 (NF2), multiple intramedullary ependymomas are known to occur. In the non-NF2 population, however, the presence of multiple synchronous intramedullary ependymomas is exceedingly rare.

Purpose

In this article, the authors report the second case in the literature of multiple primary synchronous intramedullary ependymomas. To the best of the authors knowledge, this report represents the first to provide a detailed pathology of all lesions, thereby giving an added level of confidence on the primary synchronous nature of the lesions. The authors have also performed a review of the literature regarding multifocal intramedullary ependymomas.

Study design

A review article and case report.

Conclusions

The concomitant localization of two primary intramedullary spinal cord ependymomas in the setting of nongenetic predisposition is an uncommon phenomenon. In this article, the authors present the second report of multiple, synchronous intramedullary ependymomas. A detailed review of the literature reveals that the presence of multiple intramedullary lesions in non-NF2 patients is both rare and deserving of further study.     

Hemorrhagic intramedullary hemangioblastoma of the cervical spinal cord presenting with acute-onset quadriparesis: Case report and review of the literature

Context

Hemangioblastomas of the spinal cord are uncommon vascular tumors. Patients commonly present with subtle neurologic findings that are thought to represent growth of the lesion over time. Hemorrhage of an intramedullary hemangioblastoma presenting as acute neurologic deficit is an extremely rare occurrence. Although the cervical spine is the most common location for hemangioblastoma of the spinal cord, there have been no previously published cases in the literature of intramedullary hemorrhage from such a lesion.

Findings

A 22-year-old woman with a previously undiagnosed spinal cord hemangioblastoma presented with sudden-onset dense quadriparesis due to intramedullary hemorrhage in the cervical spinal cord. The patient did not have any clinical findings of von-Hippel Lindau disease. Laminoplasty from C5 to T2 and posterior midline myelotomy for resection of the intramedullary tumor with hematoma evacuation were completed without complication.

Conclusion

Intramedullary hemangioblastoma of the spinal cord is uncommon, and hemorrhage from a cervical spinal cord lesion has not previously been reported. Symptoms from these usually indolent lesions are commonly associated with tumor growth, edema, or associated syrinx, whereas devastating acute neurologic deficit from hemorrhage is exceedingly rare. Microsurgical resection should be done in cases of symptomatic lesions and considered in isolated symptomatic lesions without the known diagnosis of von Hippel-Lindau disease.     

Dysphagia due to anterior cervical hyperosteophytosis

Background

Anterior cervical hyperosteophytosis describes the excessive formation of osteophytes along the ventral spine. Dysphagia due to ACH is considered an uncommon entity described mainly in case reports. Symptomatic ACH has been attributed to multiple etiologies including DISH, trauma, postlaminectomy syndromes, and cervical spondylosis. We report one of the largest series of patients with ACH-induced dysphagia requiring surgery.

Methods

After IRB approval, a retrospective chart review was completed. From 2001 to 2006, 9 patients presented with dysphagia due to ACH requiring surgical treatment.

Results

Eight patients were male, and the mean age was 65.1 years. Cervical spine x-rays and CT clearly demonstrated ACH in each case. Esophagram or a video fluoroscopic swallowing study was used to verify that dysphagia was caused by osteophytic overgrowth in all instances but one. In 2 patients, a focal osteophyte had formed adjacent to a previously fused segment. Of the remaining 7 patients, osteophytic formation was attributed to cervical spondylosis in 2 patients and DISH in 5 patients. All patients underwent osteophytectomy without spinal fusion. Average follow-up was 9.8 months. Although all 9 patients experienced resolution of dysphagia, improvement was delayed in 2 patients.

Conclusions

Diffuse idiopathic skeletal hyperostosis and spondylosis are the most common etiologies accounting for ACH-induced dysphagia. Adjacent segment disease may also be a potential cause of symptomatic ACH and has not been previously reported. Regardless of etiology, surgical resection is highly successful if conservative measures fail.     

Evidence-based analysis of adjacent segment degeneration and disease after ACDF: a systematic review

Background context

Follow-up studies of patients undergoing anterior cervical discectomy and interbody fusion (ACDF) have demonstrated varying degrees of radiographic degeneration at adjacent levels, with most cases being asymptomatic (adjacent segment degeneration, ASDeg) and far fewer being symptomatic (adjacent segment disease, ASDz). Controversy remains as to whether these conditions are related to altered biomechanics or represent the natural history of cervical spondylosis at the adjacent segment.

Purpose

To provide an evidence-based analysis of the peer-reviewed literature on clinical studies of ASDeg and ASDz after ACDF.

Study design/setting

Systematic review of existing literature.

Methods

The MEDLINE database was queried for clinical studies reporting ASDeg and/or ASDz after ACDF. Articles written in the English language with a minimum follow-up of 2 years were independently reviewed and analyzed by two authors, and the level of evidence was assigned. Data were pooled to generate summary outcomes and organized by number of levels, technique, and graft/implants.

Results

Of the 238 articles returned from the MEDLINE database query, 14 met inclusion criteria. An average of 168 patients was enrolled per study with an average follow-up of 106.5 months. Graft materials, cage design, plate fixation system, and length of fusion varied widely. Additionally, no clear standard was seen for radiographic assessment modalities (eg, plain lateral radiograph, flexion-extension radiographs, computed tomography, or magnetic resonance imaging). Validated clinical outcome measures were used in 43% (6/14) of the studies. The average incidence of ASDeg was 47.33% (459.14/970) with a range from 16% to 96%. The frequency-weighted average for ASDz was 11.99% (263.70/2,199) with a range from 1.80% to 36.00%. Follow-up ranged from 24 to 296 months with no reliable commonalities, which prohibited a meta-analysis.

Conclusions

This review highlights the heterogeneous methodology of the peer-reviewed literature on ASDeg and ASDz after ACDF and the paucity of high-level clinical data published on these conditions. Despite the low level of evidence to define the incidence of ASDeg and ASDz, it is clear that radiographic ASDeg is more common than symptomatic ASDz, indicating that adjacent segment pathology remains subclinical in a large subset of patients. This analysis underscores the need for standardized radiographic measures in the assessment of ASDeg and validated clinical outcome measures for ASDz after ACDF. Consistent methodology and multi-surgeon collaboration may improve the quality of clinical data on ASDeg and ASDz and elucidate the true etiology and incidence of these conditions.     

Progressive severe kyphosis as a complication of multilevel cervical percutaneous facet neurotomy: a case report

Background context

Percutaneous facet neurotomy is a procedure commonly used for the treatment of pain thought to originate from zygoapophyseal joint dysfunction. Some practitioners have also used this technique to treat cervicogenic headache. Previously reported complications for this procedure have been minimal and have included dysthesias and local pain.

Study design

Case report.

Methods

Bilateral multilevel cervical percutaneous facet neurotomies were used to treat a patient suffering from a chronic headache and neck pain that had failed to respond to extensive medical management.

Results

Within days of completing the bilateral facet neurotomies, the patient developed head drop. Subsequent electromyography revealed denervation of the patient's paraspinous muscles. Initially the patient was managed conservatively in a cervical collar with the hope that he would recover some function. After few years, the patient developed fixed kyphotic deformity. Correction of the patient's deformity required multilevel anterior cervical discectomy and fusion followed by posterior instrumented fusion.

Conclusions

When performing multilevel percutaneous cervical facet neurotomies, there is a risk of paraspinous muscle denervation, and subsequent kyphotic deformity may occur. The likelihood of this rare and previously unreported complication can probably be reduced by proper needle positioning and by minimizing the number of levels at which the procedure is performed.     

Bilateral cervical spondylolysis of C7

Background context

Cervical spondylolysis, which is defined as a cleft between the superior and inferior articular facets of the articular pillar, is a rare condition. The sixth cervical vertebra (C6) is the level most commonly affected. Cases involving C2, C3, C4, or C5 have also been reported. However, to date, no case of C7 spondylolysis has been reported.

Purpose

To present a rare case of bilateral spondylolysis of the seventh cervical vertebra (C7) in a 58-year-old man.

Study design

A case report.

Methods

A 58-year-old man visited our hospital with chronic posterior neck pain radiating to the left upper extremity. Magnetic resonance imaging (MRI) study revealed left foraminal disc herniations at C5–C6 and C6–C7. Cervical spondylolysis involving C7 was discovered incidentally during computed tomography (CT)–guided transforaminal steroid injection. Plain radiographs, CT images, and MRIs were reviewed thoroughly once again.

Results

The patient’s symptoms were relieved after he received CT-guided transforaminal steroid injections. Plain radiographs revealed a radiolucent defect in the articular pillar and cleft at the spinous process of C7. Computed tomography confirmed bilateral spondylolysis and spina bifida occulta of the C7 vertebra. Magnetic resonance imaging revealed absence of edema, which was suggestive of a chronic lesion.

Conclusion

Involvement of C7 is not exceptional in a case of cervical spondylolysis.     

Ileocecal duplication cysts: Is the loss of the valve always necessary?

Background

Ileocecal (IC) duplication cysts are enteric duplications located at the IC junction, not clearly identified in all the published series. The reported treatment is IC resection and ileocolic anastomosis. It is well known that the loss of the IC valve has several adverse effects. This study is aimed at demonstrating that cyst removal together with the common ileal wall and following enterorrhaphy is possible, safe, and effective in preserving the IC region.

Methods

Medical records of 3 patients who underwent surgery for IC duplication between 2003 and 2013 were retrospectively reviewed evaluating follow-up results.

Results

All patients had an antenatal diagnosis of intraabdominal cystic mass. In two cases associated malformations were reported. The lesions presented at newborn age with intermittent small bowel obstruction and required removal. No patients underwent IC resection. The diagnosis of duplication cyst was confirmed by histo-pathologic examination. The postoperative course was uneventful, even in the long-term follow-up.

Conclusions

Our conservative approach is a simple and safe technique, effective in avoiding the loss of the IC valve in children with duplication at the IC junction.     

Predictors and prevalence of patients undergoing additional kyphoplasty procedures after an initial kyphoplasty procedure

Background context

Vertebral cement augmentation, including kyphoplasty, has been shown to be a successful treatment for pain relief for vertebral compression fracture (VCF). Patients can sustain additional symptomatic VCFs that may require additional surgical intervention.

Purpose

To examine the prevalence and predictors of patients who sustain additional symptomatic VCFs that were treated with kyphoplasty.

Study design

A retrospective review of patients who previously underwent kyphoplasty for VCFs and had additional VCFs that were treated with kyphoplasty.

Patient sample

A total of 256 patients underwent kyphoplasty for VCFs from 2000 to 2007 at a single medical center.

Outcome measures

The outcome measure of interest was the need for an additional kyphoplasty procedure for a symptomatic VCF.

Methods

Risk factors such as age, sex, smoking status, and steroid use were assessed, as well as bisphosphonate use. Sagittal spinal alignment via Cobb angles for thoracic, thoracolumbar, and lumbar regions was assessed.

Results

About 22.2% of the patients had an additional symptomatic VCF that was treated with a kyphoplasty procedure. Steroid use was the only significant risk factor for predicting patients with additional symptomatic VCFs who underwent additional kyphoplasty. The average time to the second VCF was 33 days. Adjacent-level VCFs were most common in the thoracic and thoracolumbar spine. Bisphosphonate use was not shown to be protective of preventing additional VCFs during this follow-up period.

Conclusion

This is the first single-center review of a large cohort of patients who underwent additional-level kyphoplasty for symptomatic VCFs after an index kyphoplasty procedure. Our results suggest that patients with a VCF who use chronic oral steroids should be carefully monitored for the presence of additional symptomatic VCFs that may need surgical intervention. Patients with prior thoracic VCFs who have additional back pain should be reevaluated for a possible adjacent-level fracture.     

Surgical excision of ununited hook of hamate fractures via the carpal tunnel approach

Introduction

Direct excision of a symptomatic ununited hook of hamate fracture is the gold standard, most frequently via a Guyon space approach. The open carpal tunnel approach is another option, which has not previously been commonly considered and not reported in a peer review journal. Our study aims to highlight the carpal tunnel approach as a successful technique in a consecutive series of ununited hook of hamate fractures.

Patients and methods

Seven patients (all male and mean age 30.7 years) were reviewed with symptomatic ununited fractures following a period of cast immobilization. All the patients operated on underwent excision of the hook of hamate fragment via the open carpal tunnel approach.

Results

All patients successfully returned to their pre-injury level of functioning after 8–12 weeks and there were no complications.

Conclusions

Our study highlights the open carpal tunnel approach as a successful technique for open excision of symptomatic ununited hook of hamate fractures, because of its familiarity, ease of performance, excellent visualization and low morbidity.Level of Evidence IV Case Series.     

Cervicothoracic intraspinal pseudomeningocele with cord compression after a traumatic brachial plexus injury

Background context

Pseudomeningoceles are noted within the neural foramen after avulsion plexus injuries. We present the case of a cervicothoracic epidural pseudomeningocele with spinal cord compression 18 years after a brachial plexus injury.

Purpose

To present a case report of a patient and literature review on cases with epidural pseudomeningoceles.

Study design

Case report and review of the literature.

Methods

Retrospective review of the medical records of a patient presenting with an epidural pseudomeningocele after a plexus injury.

Results

A 37-year-old male presented with neurological decline 18 years after sustaining a brachial plexus injury. Magnetic resonance tomography revealed an epidural fluid collection from C5 to T7 with significant spinal cord compression. Surgical intervention initially involved fenestration of the cyst and then rhizotomies of the C7 and C8 roots resulting in resolution of his new symptoms.

Conclusions

Pseudomeningoceles are common after brachial plexus avulsion injury and are usually stable, causing no symptoms, other than plexus neuropathies. We are unaware of previous reports of a patient with a traumatic brachial plexus avulsion who developed a large cervicothoracic, symptomatic, spinal, epidural, intracanalicular pseudomeningocele with cord compression 18 years after the initial injury. Patients with prior trauma and known plexus injuries with development of new neurological symptoms should be evaluated for the rare case of intradural pseudomeningoceles. Preoperative imaging with computed tomography myelography is important to isolate and definitively treat the fistulous connection.     

An unexpected complication of occipitocervical stabilization surgery: retropharyngeal hematoma

Background context

To report a unique case of an unexpected complication of occipitocervical stabilization surgery that is retropharyngeal hematoma (RH).

Purpose

Postoperative RH is a very rare complication and has never been reported after posterior occipitocervical surgery.

Study design

Case report.

Methods

A 44-year-old woman being treated for rheumatoid arthritis for 20 years was admitted to our hospital in a wheelchair with the complaints of neck pain and weakness in both upper and lower extremities. She was diagnosed with basilar invagination, and occipitocervical (C0–C5) transpedicular fixation with osteosynthesis using iliac autograft was performed. The airway was seen as obstructed after extubation. The airway was maintained with laryngeal mask, and computed tomography revealed an RH. Emergent tracheotomy was performed. The patient was decannulated because of the resorption of RH after 10 days and was discharged.

Conclusion

This patient is the first patient, to our knowledge, to be reported for unexplained RH after cervical posterior spinal surgery.     

Arthroscopic management of popliteal cysts

Background:

Management of popliteal cyst is controversial. Owing to high failure rates in open procedures, recent trend is towards arthroscopic decompression and simultaneous management of intraarticular pathology. We retrospectively analysed clinical results of symptomatic popliteal cysts after arthroscopic management at 24 month followup.

Materials and Methods:

Retrospective analysis of hospital database for patients presenting with pathology suggestive of a popliteal cyst from June 2007 to December 2012 was done. Twelve cases of popliteal cyst not responding to NSAIDS and with Rauschning and Lindgren Grade 2 or 3 who consented for surgical intervention were included in the study. All patients underwent arthroscopic decompression using a posteromedial portal along with management of intraarticular pathologies as encountered. Furthermore, the unidirectional valvular effect was corrected to a bidirectional one by widening the cyst joint interface. The results were assessed as per the Rauschning and Lindgren criteria.

Results:

All patients were followed for a minimum of 24 months (range 24-36 months). It revealed that among the study group, six patients achieved Grade 0 status while five had a minimal limitation of range of motion accompanied by occasional pain (Grade 1). One patient had a failure of treatment with no change in the clinical grading.

Conclusion:

Arthroscopic approach gives easy access to decompression with the simultaneous management of articular pathologies.     

Detection of postoperative neurologic deficits using somatosensory-evoked potentials alone during posterior cervical laminoplasty

Background context

The use of neurophysiologic monitoring during anterior and posterior cervical decompression procedures in patients with spondylotic myelopathy remains controversial. The ideal neurophysiologic monitoring modality of choice is also highly debated.

Purpose

The purpose of this study was to evaluate the utility of neurophysiologic monitoring with only somatosensory-evoked potentials (SSEPs) in a consecutive series of laminoplasty procedures with regard to the detection of new postoperative neurologic deficits.

Study design

Retrospective case series.

Patient sample

Eighty consecutive patients who underwent a posterior cervical laminoplasty were reviewed.

Outcome measures

We analyzed intraoperative SSEP amplitude and latency changes from baseline with regard to the development of new postoperative neurologic deficits.

Methods

We retrospectively reviewed 80 patients who underwent a posterior cervical “open-door” laminoplasty with a standard SSEP neurophysiologic monitoring protocol. Intraoperative SSEP amplitude and latency changes from baseline (“alerts”) were analyzed with regard to the development of new postoperative neurologic deficits.

Results

Baseline SSEP values were obtained in all patients. There were five (6%) procedures that had SSEP alerts. All alerts occurred shortly after the lamina was hinged open. Four patients with SSEP alerts developed new postoperative neurologic deficits, including three unilateral upper extremity motor and sensory deficits and one complete spinal cord injury. In the immediate postoperative period, our experience with SSEP monitoring demonstrated 4 true-positive, 75 true-negative, and 1 false-positive monitoring results.

Conclusions

In this series of laminoplasty procedures, SSEP neurophysiologic monitoring had a high sensitivity and specificity for predicting new neurologic deficits in the early postoperative period. Somatosensory-evoked potentials are an effective tool for spinal cord monitoring when performing a posterior cervical laminoplasty procedure.