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Proceed with placing an anterior plate as planned
0%
10/2159
Correct the kyphotic deformity by placing a larger interbody strut cage
1%
21/2159
Remove strut cage and monitor for return of motor and sensory signals.
92%
1996/2159
Observe for 20 minutes and then repeat motor and sensory neurophysiologic testing
5%
107/2159
Close the wound and proceed with an emergency MRI
12/2159
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The clinical situation describes a patient who has neuromonitoring abnormalities following placement of an interbody cage. Loss of sensory and motor signals have been shown to be predictive of an injury to the spinal cord. As there was a direct temporal correlation with the placement of the cage, it should be immediately removed and followed by repeated neuromonitoring signal testing. In a retrospective, single-surgeon study, Bose et. al reviewed SSEP and tceMEP readings during anterior cervical spine surgery. They concluded that SSEPs and tceMEPs can be used simultaneously to indirectly and directly monitor spinal cord motor function, respectively. In a prospective cohort study, Hillibrand et al compared SSEPs to tceMEPs during anterior cervical spine surgery and found that tceMEPs are more sensitive and specific than SSEPs in monitoring motor tract injury. In addition, they showed decreases in motor signals by tceMEP were identified earlier than decreases in sensory signals by SSEPs. A recent review article by Devlin discusses neuromonitoring in detail and includes relevant spinal cord anatomy and neuromonitoring modalities. tceMEPs provide direct monitoring of the corticospinal tracts. SSEPs allow for direct monitoring of the dorsal sensory columns and allow for indirect assessment of the ventral motor tracts, see Illustration A.
3.2
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