Neuromonitoring in orthopaedics and spine surgery
Orthopaedic and spine surgery
Orthopaedics deals with diseases, damage and malformations of the human musculoskeletal system. In the area of spinal and, in particular, intramedullary diseases (e.g. tumours), orthopaedics and spine surgery have points of intersection with neurosurgery.
Orthopaedic injuries can lead to severe paresis or paralysis
During spine surgery, functionally relevant neuronal structures are at risk. For example, a possible injury to the spinal cord running in the spinal canal or one of the spinal nerves arising from it can lead to severe paresis, paralysis and plegia. The prevention of larger injuries of this kind plays an important role in surgical orthopaedics and spine surgery once the actual treatment objective has been reached.
Importance of neuromonitoring in orthopaedics and spine surgery
Intraoperative neuromonitoring is a useful tool in orthopaedics and spine surgery when it comes to preventing intraoperative injuries. The aim of intraoperative neuromonitoring of spinal nerves is to warn the surgeon of injuries to vital neural structures. This allows the surgeons to adapt their surgical strategy accordingly.
Application of neuromonitoring in orthopaedics and spine surgery
>> Neuromonitoring has long since become indispensable during the resection of spinal – particularly intramedullary – tumours, as well as during scoliosis or kyphosis correction and other spinal fusion procedures. Neuromonitoring of the spine primarily involves monitoring afferent spinal cord pathways by recording somatosensory evoked potentials (SEPs) and efferent spinal cord pathways with motor evoked potentials (MEPs) and electromyography (EMG). By evaluating the measurements, reliable statements can be made about possible disorders of the nervous system.
>> During SEP recording, the peripheral nerves of the extremities are stimulated and the resulting response signal is recorded from the cortex.
>> In contrast, the MEP signals of a transcranial stimulation of the motor cortex are recorded from the peripheral muscles of the extremities.
>> Spinal nerves are monitored by means of electromyographic recording (EMG).
>> EMG response signals from the muscles innervated by the spinal nerves provide information about the integrity of nerves.