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Acta Orthop Belg 2020 Mar;86(1):22-27

Developmental dysplasia of the hip with a high dislocation may lead to severe hip pain and a marked shortening. Nerve palsy rates following THA in dysplastic hips have been reported as being higher by ten times or more compared to the general population. We report a new technique to perform THA in high congenital dislocations. Read More

Clin Neurophysiol 2020 May 11. Epub 2020 May 11.

Neurophysiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Spine Deform 2020 May 25. Epub 2020 May 25.

Radboud University Medical Center, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.

The Scoliosis Research Society has developed an updated information statement on intraoperative neurophysiological monitoring of spinal cord function during spinal deformity surgery. The statement reviews the risks of spinal cord compromise associated with spinal deformity surgery; the statement then discusses the various modalities that are available to monitor the spinal cord, including somatosensory-evoked potentials, motor-evoked potentials, and electromyographic (EMG) options. Anesthesia considerations, the importance of a thoughtful team approach to successful monitoring, and the utility of checklists are also discussed. Read More

Clin Neurol Neurosurg 2020 May 19;195:105915. Epub 2020 May 19.

Institute for Research on Musculoskeletal Disorders, Valencia Catholic University, 46001 Valencia, Spain. Electronic address:

Objective: To describe the accuracy of middle pedicle track stimulation for the detection of pedicle breaches causing misplaced lumbar screws and subsequent neurological symptoms.

Patients And Methods: In a comparative observational study with two cohorts, 1440 lumbar pedicle screws were implanted using the freehand technique in 242 patients undergoing surgery for spinal deformities. In the first two-year period (2011-2012), the accuracy of screw placement (802 screws) was assessed by conventional intraoperative palpation of the pedicle track, t-EMG screw stimulation, and fluoroscopic monitoring. Read More

Oper Neurosurg (Hagerstown) 2020 May 23. Epub 2020 May 23.

Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.

Dumbbell schwannoma of the cervical spine is a known entity,1-5 and should be radically resected with the preservation or improvement of neurological function. However, to our knowledge, an operative video of a C1-C2 cervical dumbbell schwannoma with ventral extension and dorsal spinal cord compression has not been reported previously. This tumor resection video performed by the senior author (KIA) includes details of dural opening, and techniques for microsurgical resection and for postoperative closure to avoid cerebrospinal fluid (CSF) leak and pseudomeningocele formation. Read More

Eur Spine J 2020 May 21. Epub 2020 May 21.

Department of Neurosurgery, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.

Purpose: Little is known about the reliability and value of intraoperative neurophysiological monitoring (IONM) in patients with Duchenne muscular dystrophy (DMD) undergoing scoliosis correction surgery. The aim of this study was to investigate the feasibility of IONM and the cortical excitability in these patients.

Methods: Fifteen patients with DMD and scoliosis and 15 patients with adolescent idiopathic scoliosis (AIS) underwent scoliosis correction surgery with the use of IONM. Read More

J Surg Case Rep 2020 May 18;2020(5):rjaa049. Epub 2020 May 18.

Division of Orthopaedic Surgery, University of Manitoba, Winnipeg, Canada.

Intraoperative neurophysiologic monitoring is a technique utilized during spinal operations to minimize sensory and motor function morbidity. We herein report a case of a 73-year-old female with renal cell carcinoma and metastatic involvement of the cervical and thoracic spine, who underwent a multilevel complex anterior and posterior operation. Neurophysiological monitoring was able to localize the lower limb ischemia utilizing somatosensory evoked potentials. Read More

Childs Nerv Syst 2020 May 21. Epub 2020 May 21.

Psychological Service, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus.

Purpose: About half of brain tumors are located in supratentorial regions and 20% of them in eloquent brain cortex areas. The use of fMRI and intraoperative neuromonitoring allows safe surgery of these areas. Carrying out awake brain surgery (ABS) operations provides additional opportunities for direct-function monitoring. Read More

Clin Neurophysiol 2020 Jul 12;131(7):1556-1566. Epub 2020 Apr 12.

Intraoperative Monitoring, Department of Neurophysiology, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN 55407, USA.

Objective: To improve estimates of motor evoked potential (MEP) performance during spine deformity surgeries by accounting for potential confounders.

Methods: A meta-analysis of MEPs for spine deformity surgeries determined the probability of a MEP deterioration which recovered by the end of surgery, P(RSC), and the conditional probability of no new post-operative deficit given an RSC, P(NND|RSC), stratified by category of intraoperative adverse event associated with the MEP deterioration. A structural causal model (SCM) and propensity score matching accounted for intraoperative adverse events and patient diagnosis as potential confounders. Read More

Neurocirugia (Astur) 2020 May 3. Epub 2020 May 3.

Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España.

Background And Objectives: The treatment of deafferentation pain by spinal DREZotomy is a proven therapeutic option in the literature. In recent years, use of DREZotomy has been relegated to second place due to the emergence of neuromodulation therapies. The objectives of this study are to demonstrate that DREZotomy continues to be an effective and safe treatment and to analyse predictive factors for success. Read More

Acta Neurol Belg 2020 May 5. Epub 2020 May 5.

University of Ferrara, Ferrara, Italy.

Tumors in primary sensory area are challenging to remove without causing a neurological deficit, especially in musicians who present complex neuronal networks. Indeed, in this kind of patients, somatosensory evoked potentials (SSEPs) are not plenty. We describe our experience for sensory and proprioception preservation in a professional clarinet player undergoing surgery for a right parietal glioblastoma. Read More

Laryngoscope 2020 May 4. Epub 2020 May 4.

Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, NY, USA.

Objective: Intraoperative neuromonitoring (IONM) techniques aim to identify and potentially prevent nerve injury during surgeries. Prior studies into the efficacy of recurrent laryngeal nerve (RLN) IONM convey mixed results, with some claiming equivalence between IONM and no monitoring at all. The goal of the current study was to compare continuous RLN monitoring using the laryngeal adductor reflex (LAR) to intermittent RLN monitoring (intermittent IONM) to determine whether continuous monitoring reduces the incidence of intraoperative RLN injury during neck endocrine surgeries. Read More

Oper Neurosurg (Hagerstown) 2020 May 1. Epub 2020 May 1.

Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Background: Surgery for peripheral nerve sheath tumors aims to preserve functional fascicles achieving gross-total resection. Increasing the visualization of anatomic details helps to identify the different layers and the tumor-nerve interface. The traditional microscope can present some limitations in this type of surgery, such as its physical obstruction. Read More

Med Sci Monit 2020 Apr 29;26:e921129. Epub 2020 Apr 29.

Orthopedic Department, Peking University Third Hospital, Beijing, China (mainland).

BACKGROUND Circumferential decompression (CD) is an essential treatment option for myelopathy associated with thoracic-ossification of the posterior longitudinal ligament (T-OPLL) when laminectomy cannot achieve sufficient ventral decompression. Although intraoperative neurophysiological monitoring (IONM) is widely used, the operation has a relatively high risk. This study is the first to describe the use of contrast-enhanced ultrasound (CEUS) to evaluate the spinal cord blood flow (SCBF) during thoracic spine surgery in humans. Read More

Otolaryngol Head Neck Surg 2020 Jun 28;162(6):985-992. Epub 2020 Apr 28.

Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, NewYork Presbyterian Hospital, New York, New York, USA.

Objective: The effectiveness of upper airway stimulation via hypoglossal nerve stimulation for obstructive sleep apnea depends upon the pattern of tongue muscle activation produced. This study investigated the nature of contralateral tongue muscle activation by unilateral hypoglossal nerve stimulation using intraoperative nerve integrity monitoring in conjunction with electromyography and explored the relationship between contralateral tongue muscle activation and polysomnographic measures of obstructive sleep apnea severity.

Study Design: Prospective case series. Read More

J Korean Neurosurg Soc 2020 May 27;63(3):272-278. Epub 2020 Apr 27.

Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Korea.

Compared to any other decade, the last two decades have been the most dynamic period in terms of advances in the knowledge on spinal dysraphism. Among the several factors of rapid advancement, such as embryology during secondary neurulation and intraoperative neurophysiological monitoring, there is no doubt that Professor Dachling Pang stood high amidst the period. I review here the last two decades from my personal point of view on what has been achieved in the field of spinal dysraphism, focusing on occult tethered cord syndrome, lumbosacral lipomatous malformation, terminal myelocystocele, retained medullary cord, limited dorsal myeloschisis and junctional neural tube defect. Read More

JSLS 2020 Apr-Jun;24(2)

Physiologic Assessment Services, Teaneck, New Jersey.

Introduction: Positioning-related neural injuries are an inherent risk in surgery, particularly in robotic-assisted abdominal wall reconstruction because of unique patient positioning and increased operative times. The implementation of intraoperative neurophysiological monitoring should be considered in such cases.

Methods: This was a two-armed study with one prospective intervention group and one retrospective control group. Read More

J Pediatr Orthop 2020 Apr 14. Epub 2020 Apr 14.

Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.

Background: Occipital plate fixation has been shown to improve outcomes in cervical spine fusion. There is a paucity of literature describing occipital plate fixation, especially in the pediatric population. The authors reviewed a case series of 34 patients at a pediatric hospital who underwent cervical spine fusion with occipital plate fixation between 2003 and 2016. Read More

Neurodiagn J 2020 Jun 16;60(2):96-112. Epub 2020 Apr 16.

Department of Orthopedic Surgery, Grace Medical Center , Lubbock, Texas.

The purpose of this study is to identify the advancing role of Intraoperative Neurophysiological Monitoring (IONM) in detecting and preventing nerve injuries during shoulder surgery procedures. We performed a retrospective analysis of IONM data from ten shoulder procedures. The patients consisted of nine females and one male with ages ranging from 67 to 81 years (median: 74 years). Read More

Oper Neurosurg (Hagerstown) 2020 Apr 16. Epub 2020 Apr 16.

Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.

Lateral medullary arteriovenous malformations (AVMs) are located in the pia on the lateral medullary surface.1 They are supplied by arterial feeders from the V4 segment of the vertebral artery or posterior inferior cerebellar artery. A 64-yr-old man presented with leg spasms and progressively worsening gait. Read More

Cureus 2020 Mar 10;12(3):e7233. Epub 2020 Mar 10.

Neurosurgery, United Regional Health Care System, Wichita Falls, USA.

A T10 to L2 spinal cord tumor exploration and biopsy was performed with intraoperative neurophysiological monitoring (IONM) on a 75-year-old male diagnosed with an intradural intramedullary appearing spinal cord lesion with no other lesions in the central nervous system, chest, abdomen or pelvis. Intraoperative neurophysiology consisted of transcranial electrical motor evoked potentials (TCeMEPs), somatosensory evoked potentials (SSEPs), triggered and spontaneous electromyography (S-EMG, T-EMG), bulbocavernosus reflex (BCR) and train of four (TOF) monitoring. Loss of BCR responses during conus exposure and identification were resolved with multiple small pauses in manipulation throughout the procedure. Read More

Clin Neurophysiol Pract 2020 10;5:59-63. Epub 2020 Mar 10.

Israel Spine Center, Assuta Medical Center, Tel Aviv, Israel.

Objective: This study examines and compares excitability characteristics of tibialis anterior (TA) and abductor hallucis (AH) transcranial motor evoked potentials (tcMEP) during anterior cervical decompression and fusion (ACDF) surgery.

Methods: Electrophysiological and clinical data of 89 patients who underwent ACDF procedure were retrospectively reviewed. TcMEP data of TA and AH muscles from 178 limbs were analyzed for availability, robustness and stability during the procedure. Read More

Surg Neurol Int 2020 6;11:42. Epub 2020 Mar 6.

Department of Neurosurgery, Hospital Clínico Regional de Concepción, Concepción, Bio-Bio, Chile.

Background: The standard of care is to utilize intraoperative neurophysiological monitoring (IOM) of triggered electromyography (tEMG) during posterior lumbosacral instrumented-fusion surgery. IOM should theoretically signal misplacement of S1 screws into the neural L5-S1 foramen or spinal canal, utilizing screw stimulation, and recording of the lower limb muscles and the anal sphincter. Here, we evaluated when and whether anterolateral S1 screw malposition could be detected by IOM/tEMG during open posterior lumbosacral instrumented fusion surgery. Read More

Childs Nerv Syst 2020 Jun 3;36(6):1181-1186. Epub 2020 Apr 3.

Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Piazzale Stefani 1, 37124, Verona, Italy.

Purpose: Cerebellar mutism (CM) is a condition that occurs predominantly in children, after posterior fossa surgery (PFS). It is characterized by motor, speech, and behavioral disorders. Despite widespread use of intraoperative neurophysiological monitoring (IONM), little is known about the neurophysiological aspects involved in the pathophysiology of CM. Read More

Neurosurg Focus 2020 04;48(4):E9

1Department of Neurological Surgery, University of Washington.

Functional hemispherectomy/hemispherotomy is a disconnection procedure for severe medically refractory epilepsy where the seizure foci diffusely localize to one hemisphere. It is an improvement on anatomical hemispherectomy and was first performed by Rasmussen in 1974. Less invasive surgical approaches and refinements have been made to improve seizure freedom and minimize surgical morbidity and complications. Read More

HNO 2020 Mar 26. Epub 2020 Mar 26.

Department of Otolaryngology, Head/Neck & Facial Plastic Surgery, Sana Kliniken Leipziger Land, Rudolf-Virchow-Straße 2, 04552, Borna, Germany.

Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Read More

J Stroke Cerebrovasc Dis 2020 May 14;29(5):104711. Epub 2020 Mar 14.

Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. Electronic address:

Background And Purpose: Perioperative stroke remains a devastating complication after cardiac surgery and is associated with significant morbidity and mortality. Despite the significant contribution of stroke to perioperative mortality, risk factors for perioperative stroke-related mortality have not been well characterized. Our aim was to identify independent predictors of perioperative stroke-related mortality after cardiac surgery, using the Pennsylvania Health Care Cost Containment Council (PHC4) database which provides information on cause of death. Read More

HNO 2020 Mar 10. Epub 2020 Mar 10.

Klinik für HNO-Heilkunde, Kopf‑/Hals- und plastische Gesichtschirurgie, Sana Kliniken Leipziger Land, Rudolf-Virchow-Straße 2, 04552, Borna, Deutschland.

Although the history of intraoperative neuromonitoring (IONM) dates back to the 19th century, the method did not evolve further than the mere differentiation of nerves until recently. Only the development of continuous IONM (cIONM) has allowed for non-stop analysis of excitation amplitude and latency during surgical procedures, which is nowadays integrated into the software of almost all commercially available neuromonitoring devices. The objective of cIONM is real-time monitoring of nerve status in order to recognize and prevent impending nerve injury and predict postoperative nerve function. Read More

Otolaryngol Head Neck Surg 2020 May 10;162(5):773-775. Epub 2020 Mar 10.

Department of Otorhinolaryngology, College of Medicine, Pusan National University, Busan, Republic of Korea.

We developed an attachable magnetic nerve stimulator (AMNS) that connects the metallic instruments to a neurophysiological monitoring unit for monitoring the facial nerve (FN) during ear surgery and present our experiences with intraoperative neuromonitoring (IONM) of the FN using AMNS. The FN in 20 patients who underwent tympanomastoidectomy for chronic ear disease was examined. The electromyography (EMG) amplitudes of the FN using AMNS were assessed. Read More

J Clin Neurophysiol 2020 Mar 4. Epub 2020 Mar 4.

Comprehensive Epilepsy Center of Long Island, Port Jefferson, New York, U.S.A.

Introduction: Intraoperative neurophysiological monitoring (IONM) is widely used to prevent nervous system injury during surgeries in elderly patients. However, there are no studies that describe the characteristics and changes in neurophysiological tests during the IONM of patients aged 60 years and older. The study aims to describe and compare IONM changes during surgeries in adult patients aged 18 to 59 years with those aged 60 years and older. Read More

Acta Chir Orthop Traumatol Cech 2020 ;87(1):39-47

I. Ortopedicko-traumatologická klinika, Lekárskej fakulty Univerzity Komenského, Slovenskej zdravotníckej Univerzity a Univerzitnej nemocnice Bratislava.

PURPOSE OF THE STUDY This retrospective study investigated the significance of a combination of peak latency of waveform amplitude and waveform amplitude in association with spinal deformities. The correlation with postoperative neurologic deficit was evaluated too. MATERIAL AND METHODS Between January 2007 and January 2018, a group of 113 patients was evaluated in the study who underwent spine surgery using intraoperative neurophysiological monitoring (IONM) focusing on transcranial motor evoked potential (tc-MEP) monitoring. Read More

J Neurosurg Spine 2020 Mar 6:1-6. Epub 2020 Mar 6.

Departments of1Neurological Surgery and.

Objective: Posterior thoracic fusion (PTF) is used as a surgical treatment for a wide range of pathologies. The monitoring of somatosensory evoked potentials (SSEPs) is used to detect and prevent injury during many neurological surgeries. The authors conducted a study to evaluate the efficacy of SSEPs in predicting perioperative lower-extremity (LE) neurological deficits during spinal thoracic fusion surgery. Read More

J Neurosurg Pediatr 2020 Feb 28:1-10. Epub 2020 Feb 28.

Departments of1Neurosurgery.

Objective: Selective dorsal rhizotomy (SDR) is effective at permanently reducing spasticity in children with spastic cerebral palsy. The value of intraoperative neurophysiological monitoring in this procedure remains controversial, and its robustness has been questioned. This study describes the authors' institutional electrophysiological technique (based on the technique of Park et al. Read More

Int J Surg Case Rep 2020 6;67:271-276. Epub 2020 Feb 6.

Department of Paediatrics, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, 518034, China.

Introduction: Intraoperative neurophysiological monitoring (IONM) has been widely used in spinal surgery. There is lack of report about IONM for the treatment of upper lumbar disc herniation (HIVD) with percutaneous endoscopic lumbar discectomy (PELD), the relationship between an immediate increase in amplitude of intraoperative MEP after decompression and improvement of the treated levels is rarely studied. Here we reported a surgical case in which an elderly patient with HIVD underwent PELD with IONM and there was a distinct increase in the amplitude of MEP after decompression, showing an immediate improvement of the treated levels. Read More

Turk Neurosurg 2020 ;30(2):252-262

Medical Faculty University of Belgrade, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia.

Aim: To analyze the impact of intraoperative neurophysiological monitoring (IONM) on the extent of removal and long-term neurological outcomes in a series of grade II ependymomas.

Material And Methods: We retrospectively reviewed 88 consecutive patients who underwent surgical resection of an intramedullary spinal cord tumor (IMSCT) at the Clinic of Neurosurgery of the Clinical Center of Serbia in Belgrade between January 2012 and December 2017. In all, 39 patients (25 males and 14 females; mean age 46. Read More

Sci Rep 2020 Feb 18;10(1):2819. Epub 2020 Feb 18.

Institute for Research in Technology, ICAI School of Engineering, Pontifical Comillas University, Madrid, Spain.

Intraoperative Neurophysiological Monitoring is a set of monitoring techniques consisting of reading electrical activity generated by the nervous system structures during surgeries. In order to guarantee signal quality, contact impedance between the sensing electrodes and the patient's skin needs to be as low as possible. Hence, monitoring this impedance while signals are measured is an important feature of current medical devices. Read More