Spine Surgeons Prineville OR
Medical School: Or Hlth Sci Univ Sch Of Med, Portland Or 97201
Graduation Year: 1989
Medical School: Univ Of Il Coll Of Med, Chicago Il 60680
Graduation Year: 1970
Hospital: Memorial Hospital At Oconomowo, Oconomowoc, Wi; Waukesha Memorial Hospital, Waukesha, Wi
Group Practice: Orthopaedic Assoc-Waukesha
Medical School: Loma Linda Univ Sch Of Med, Loma Linda Ca 92350
Graduation Year: 1973
Hospital: Mountain View Hospital Dist, Madras, Or; Central Oregon District Hosp, Redmond, Or
Group Practice: Redmond Orthopedic Clinic
Grants Pass, OR
Adult Reconstructive Orthopaedic Surgery
Medical School: Univ Of Vt Coll Of Med
Year of Graduation: 1997
Accepting New Patients: Yes
5.0, out of 5 based on 3, reviews.
Lake Oswego, OR
Medical School: Northwestern Univ Med Sch, Chicago Il 60611
Graduation Year: 1967
Orthopedic Surgery, Hand Surgery
Oregon City, OR
Monitoring Spinal Function During Spine Surgery
Any spine surgery is a very delicate operation. Care must be taken to prevent damage to the spinal cord, spinal nerves, and blood vessels supplying these neural components. Damage to the blood vessels and loss of blood supply to the spinal cord can have serious consequences.
Surgeons have an important tool available during spinal surgery to monitor patients called intraoperative neuromonitoring or IOM. IOM methods include the wake-up test, somatosensory-evoked potentials (SSEP), transcranial motor-evoked potentials (tcMEP), spinal cord MEPs, spontaneous electromyography (sEMG), and triggered electromyography (tEMG).
Each one of these tests has its own purposes and functions. But the basic idea behind this type of monitoring is to make sure moment-by-moment during the procedure that no injury has occurred. This is called real-time monitoring. Warning is given so that any damage can be prevented or reversed.
The tests must be accurate enough to avoid any false positives or false negatives. A false positive means the test says there's a problem when there really isn't one. A false negative is a test that doesn't indicate a problem when there is one.
In this study, neurosurgeons from the University of Pennsylvania and University of Virginia reviewed studies published on intraoperative neuromonitoring (IOM). They wanted to know how sensitive are each of the tests. Surgeons need to know what test values require immediate action.
Having these tests makes it possible to perform more complex spinal surgeries. That's important for patients with severe scoliosis undergoing spinal correction to get the best possible result. The same is true for cancer patients with spinal tumors that have to be removed. It allows the surgeon to be more aggressive when it's needed and with less risk of complications.
For each of the IOM tests, the authors provide a description of the test, when it would be used, and what the research reports about reliability, validity, and effectiveness of each test. Surgeons are given ways to avoid problems and obstacles with each test. A summary of all the technical information is provided with key points from the article offered in the conclusion.
Here's a sample of the type of information surgeons can obtain from this review. The wake-up test (gradually reducing the amount of anesthesia until the patient wakes up enough to move their arms and legs) has many more drawbacks than benefits compared to the other tests. It's easy to do but only offers a one-time look at what's going on when really ongoing monitoring is much better. It should only be used along with a more consistent test.
Somatosensory-evoked potentials (SSEPs) became popular in the late 1980s and early 1990s. They were thought to be reliable but it turned out there was a high rate of false negatives. SSEPs don't monitor all aspects of spinal cord, spinal nerve, and vascular (blood supply) function. They are not reliable to test mot...