Spine Surgeons Somerville MA

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Brian J Awbrey MD
(617) 726-3808
151 Merrimac St
Boston, MA
Specialties
Orthopedics

Data Provided By:
Elliott L Thrasher, MD
(617) 491-6766
300 Mount Auburn St Ste 505
Cambridge, MA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Wv Univ Sch Of Med, Morgantown Wv 26506
Graduation Year: 1966

Data Provided By:
James Allan Karlson
(617) 491-6766
300 Mount Auburn St
Cambridge, MA
Specialty
Orthopedic Surgery

Data Provided By:
John Kenneth Schuler, MD
1493 Cambridge St
Cambridge, MA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Univ Of Cincinnati Coll Of Med, Cincinnati Oh 45267
Graduation Year: 1975

Data Provided By:
Gerald Steinberg
(617) 665-1566
1493 Cambridge St
Cambridge, MA
Specialty
Orthopedic Surgery

Data Provided By:
Lawrence Ira Karlin, MD
(617) 355-6021
300 Longwood Ave
Boston, MA
Business
Children's Hospital Boston Orthopaedic Surger
Specialties
Orthopedics

Data Provided By:
Leo Joseph Troy Jr, MD
(617) 491-6766
300 Mount Auburn St Ste 505
Cambridge, MA
Specialties
Orthopedics
Gender
Male
Education
Medical School: Harvard Med Sch, Boston Ma 02115
Graduation Year: 1979

Data Provided By:
James G Manson, MD
(617) 491-4122
Cambridge, MA
Specialties
Orthopedics
Gender
Male
Education
Graduation Year: 2007

Data Provided By:
Byron Vartan Hartunian
(617) 864-5700
777 Concord Ave
Cambridge, MA
Specialty
Orthopedic Surgery

Data Provided By:
Ronald Henry Geiger
(617) 491-6766
300 Mount Auburn St
Cambridge, MA
Specialty
Orthopedic Surgery

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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...

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