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    Does intraoperative neurophysiological monitoring have predictive value for functional recovery following spinal cord injury? A case report

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    Authors
    Eck, Jason C.
    Martin, Christopher J.
    Lapinsky, Anthony
    Connolly, Patrick J.
    DiPaola, Christian P.
    UMass Chan Affiliations
    Department of Orthopedic Surgery
    Department of Orthopedics and Physical Rehabilitation
    Document Type
    Journal Article
    Publication Date
    2013-02-01
    Keywords
    Spinal Cord Injuries
    Monitoring, Intraoperative
    Nervous System Diseases
    Orthopedics
    Rehabilitation and Therapy
    Surgery
    
    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1007/s10877-012-9395-4
    Abstract
    To present a case report of a patient with an ASIA B spinal cord injury with partially intact baseline IONM who made a complete functional recovery postoperatively. A thirty-three year old male presented after a motor vehicle accident. Imaging studies revealed a C4-C5 bilateral facet dislocation. On presentation the patient had 4/5 strength in bilateral biceps and wrist extensors, 3/5 strength in bilateral triceps, and 0/5 strength in the finger flexors, intrinsics and all lower extremity muscles. Motor level was C7. Sensation was grossly intact to light touch throughout all extremities, intact to pinprick from C2 to T7, and absent to pinprick caudal to T7. Rectal tone and contraction were absent. After attempts at closed reduction failed the patient underwent an open reduction and posterior C4-C5 fusion. Intraoperative neurophysiologic monitoring (IONM) revealed the presence of baseline responses to the posterior tibial nerve using somatosensory evoked potentials and to the right abductor hallucis using transcranial motor evoked potentials. At the 6 weeks postoperative visit the patient had full 5/5 motor strength to all muscles except the left deltoid that was 4/5 due to a rotator cuff injury. This case illustrates a potential prognostic value of IONM. Despite lack of clinical motor function at the time of surgery, IONM was able to illicit a motor response in the right lower extremity. Further prospective studies are needed for further investigation.
    Source
    J Clin Monit Comput. 2013 Feb;27(1):93-6. doi: 10.1007/s10877-012-9395-4. Link to article on publisher's site
    DOI
    10.1007/s10877-012-9395-4
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/42930
    PubMed ID
    22941585
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1007/s10877-012-9395-4
    Scopus Count
    Collections
    UMass Chan Faculty and Researcher Publications
    Orthopedics and Physical Rehabilitation Publications

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