Electrical stimulation and multichannel EMG recording for identification of functional neural tissue during cauda equina surgery |
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Authors: | Alan D Legatt Charles E Schroeder Bhagwant Gill James T Goodrich |
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Institution: | (1) Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA;(2) Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA;(3) Department of Urology, Albert Einstein College of Medicine, Bronx, New York, USA;(4) Department of Neurosurgery, Albert Einstein College of Medicine, Bronx, New York, USA;(5) Montefiore Medical Center, Bronx, New York, USA;(6) Department of Neurology, Montefiore Medical Center, 111 East 210th Street, 10467 Bronx, NY, USA |
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Abstract: | Electrical stimulation of structures within the surgical field was used to identify functional neural elements during 25 cauda equina operations. EMG responses from anterior thigh, posterior thigh, and anal sphincter muscles were recorded simultaneously using a multichannel signal averager. During nine operations, stimulation of a presumed filum terminale or other tissue produced clear EMG responses, prompting modification of surgical procedures. In one patient, this resulted in preservation of a flattened spinal cord which resembled a band of scar tissue. Some EMG responses were restricted to a single muscle group; these neural structures would probably not have been identified if only a single-channel EMG recording was used. Visual examination alone was not adequate for identifying functional neural elements, or for determining whether atretic-appearing nerve roots were functional. Electrical stimulation with multichannel EMG recording facilitates the preservation of functional neural elements and the optimization of surgical results in cauda equina surgery. |
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Keywords: | Cauda equina surgery Electric stimulation Electromyography Evoked potentials somatosensory Intraoperative neurophysiologic monitoring Tethered spinal cord |
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