J Clin Monit Comput - Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials.

Tópicos

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Resumo

We have previously investigated electromyographic (EMG) and transcranial motor evoked potential (MEP) abnormalities after mechanical spinal cord injury. We now report thermally generated porcine spinal cord injury, characterized by spinal cord generated hindlimb EMG injury activity and spinal cord motor conduction block (MEP loss). Electrocautery (EC) was delivered to thoracic level dural root sleeves within 6-8 mm of the spinal cord (n = 6). Temperature recordings were made near the spinal cord. EMG and MEP were recorded by multiple gluteobiceps intramuscular electrodes before, during, and after EC. Duration of EC was titrated to an end-point of spinal motor conduction block (MEP loss). In 5/6 roots, ipsilateral EMG injury activity was induced by EC. In 4/5 roots, EMG injury activity was identified before MEP loss. In all roots, a minimum of 20 s EC and a temperature maximum of at least 57 ?C at the dural root sleeve were required to induce MEP loss. Unexpectedly, conduction block was preceded by an enhanced MEP in 4/6 trials. EMG injury activity, preceding MEP loss, can be seen during near spinal cord EC. Depolarization and facilitation of lumbar motor neurons by thermally excited descending spinal tracts likely explains both hindlimb EMG and an enhanced MEP signal (seen before conduction block) respectively. A thermal mechanism may play a role in some unexplained MEP losses during intraoperative monitoring. EMG recordings might help to detect abnormal discharges and forewarn the monitorist during both mechanical and thermal injury to the spinal cord.

Resumo Limpo

previous investig electromyograph emg transcrani motor evok potenti mep abnorm mechan spinal cord injuri now report thermal generat porcin spinal cord injuri character spinal cord generat hindlimb emg injuri activ spinal cord motor conduct block mep loss electrocauteri ec deliv thorac level dural root sleev within mm spinal cord n temperatur record made near spinal cord emg mep record multipl gluteobicep intramuscular electrod ec durat ec titrat endpoint spinal motor conduct block mep loss root ipsilater emg injuri activ induc ec root emg injuri activ identifi mep loss root minimum s ec temperatur maximum least c dural root sleev requir induc mep loss unexpect conduct block preced enhanc mep trial emg injuri activ preced mep loss can seen near spinal cord ec depolar facilit lumbar motor neuron thermal excit descend spinal tract like explain hindlimb emg enhanc mep signal seen conduct block respect thermal mechan may play role unexplain mep loss intraop monitor emg record might help detect abnorm discharg forewarn monitorist mechan thermal injuri spinal cord

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