Cervical SSEP changes

Question 1

Risk associated with intubation

Answer 1

Neck extension may cause compression of spinal cord

Question 2

Risk associated with positioning

Answer 2

Spinal cord may be sensitive to it. Arterial flow to the head could also be affected

Question 3

Risk associated with traction on head

Answer 3

Too much traction can cause stretching of the spinal cord

Question 4

Risk associated with taping of the shoulders

Answer 4

Can cause stretching of the brachial plexus or impingement of UE circulation

Question 5

Risk associated with tucking of arms

Answer 5

Too tightly tucked can disrupt blood flow in the arm, or place pressure on nerves

Question 6

Risks during exposure

Answer 6

Retraction of the neck tissue could indadvertedly manipulate the carotid artery causing occlusion or release of emboli in patients with heart disease

Question 7

Risks during diskectomy

Answer 7

Removal of disc removal can cause compression of the spinal cord or nerve roots with insertion of instruments. Removing disc that is adherent to the dura can rip the dura and disrupt the spinal cord

Question 8

Risks during laminectomy

Answer 8

Insertion of the instrument can place pressure not the spinal cord or nerve roots. Dorsal column tracts and posterior spinal circulation are especially vulnerable. Can also disrupt the dura

Question 9

Risks during foramenotomy

Answer 9

Decompression of the intervertebral foramen places direct risk to the spinal nerve roots

Question 10

Risks with inter body graft placement

Answer 10

Tapping of the graft too deeply can cause blunt trauma and/or compression of the spinal cord

Question 11

Risks with anterior plate and vertebral body screws

Answer 11

Plate placement can shift an overused graft into the spinal canal, compressing the spinal cord. Screws that are too long can penetrate into the spinal cord

Question 12

Risks with posterior screw placement

Answer 12

Malpositioned screws can injure the nerve roots or a vertebral artery. A medial placement could cause injury to the lateral spinal cord

Question 13

Risks with tumor removal

Answer 13

Spinal cord manipulations including cutting, retracting, stretching, compression or disruption of a spinal artery blood flow are all possible

Question 14

What do PTN SSEPs monitor in Cervical surgeries

Answer 14

Monitors dorsal column function through surgical site (fasciculus gracilis)

Question 15

What do arm and hand EMGs monitor in Cervical surgeries

Answer 15

Monitors nerve root irritation, and important for nerve root manipulations during decompression and screw placement

Question 16

What do MN SSEPs monitor in Cervical surgeries

Answer 16

Monitors general brachial plexus function and cervical spinal cord. Important for monitoring physiologic and anesthetic effects, and malpositioning. May not be sensitive to isolated nerve root injuries or to spinal cord injuries below C5 (due to entry point into the spinal cord)

Question 17

What do TcMEPs monitor in Cervical surgeries

Answer 17

Monitors lateral corticospinal tract function through surgical site