Re: Intraop Monitoring/ SSEP's and EMG's

Posted By Erin Sullivan on May 01, 1999 at 09:15:10
I'm in Harrisburg, PA and work at a local hospital. I do intraoperative monitoring for a spine surgeon and for acoustic neuromas. I actially have two questions:
1) Where can I find basic "how to do" SSEP's information? I've been looking on the web, but most of what I find are pros/cons with surgery. I'd like to have more information about the waves and basic interpretation aspects of SSEPS. I also do triggered EMG's for pedicle screws and need more infor on reading EMG's.
2) What is your views on intraoperative monitoring? Some of our surgeons use it and some don't. Just wondering.
Thanks for your time.

[CCF Neurology W6 MD]

Posted By CCF  Neurology W6 MD on May 02, 1999 at 09:12:38
Hello there,
thank you for your question,
there are several books out there specifically dealing with intraoperative
monitoring:
Primer in Intraoperative Neurophysiology Monitoring by Gerald Russel
Intraoperative Neurophysiology Monitoring by A. Moller
For Evoked potential, my classic favorite is
Spehlmann's Evoked Potential Primer
At the CCF we do intraoperative monitoring on many procedures, you're right
that it is largely surgeon's preference altough in some procedure it's pretty  much routinely done (spine, brainstem, epilepsy surgery).
Good luck.

[legers]

Posted By legers on June 08, 1999 at 23:08:08
This question does not involve intraop monitoring, but I would like some clarification of the ssep and the emg.  Diminished reflexes can be a sign of neuropathy, correct me if I am wrong.  It would mean that there is a problem in the surface nerves or nerve roots.  One has a EMG done, neuropathy is ruled out, but radiculopathy is found on one side, lower limb.  Prior to that, SSEP performed, (this testing is for central nervous system I assume)  delayed lower extremities, no location to pinpoint due to unregisterable nerves, just delayed p37.  One would think that the side that would be more delayed would be the radiculopathy side.  What would it mean, if the "good" side was more delayed than the radiculopathy?  If the reflexes, per say were in semi-good state when tests were performed ranges between 1+ to 2+ but now diminished to 0 to trace, (reflexes tested regularly) should the ssep test be re-performed?  What would you look for in the problem of lost reflexes with the current results of an emg showing no neuropathy?  The problem spread from the legs to the arms.
Thank you for any input that you may have to offer.










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