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Spine > Miller's Review Spine > Flashcards

Miller's Review Spine Flashcards

Ortho spine review

1
Q

SPECT CT commonly used to evaluate ___

A

Spondylolysis. SPECT is a bone scan overlying a CT scan

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2
Q

Most common lumbar levels of spondylosis

A

L4-5 > L5-S1 > L3-L4

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3
Q

MRI findings in lumbar spondylosis

A

As the nucleus pulposis degenerates, you get decreased T2 signal in the disc (dark disc disease)

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4
Q

Physical exam maneuvers for discogenic back pain

A

Straight leg raise with radicular symptoms and femoral stretch with radicular symptoms

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5
Q

1st step in pathway of disc degeneration

A

Tear in annulus fibrosus

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6
Q

Nerve block for facetogenic back pain

A

Medial branch of dorsal rami

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7
Q

Most common direction for disc herniations

A

Posterolateral, adjacent to the stout posterior longitudinal ligament

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8
Q

Most common nerve compressed in lumbar disc herniation?

A

L5 root. L4-L5 disc herniation is the most common, posterolateral is most common, so it compresses the traversing L5 nerve root (not the exiting L4 nerve root at the L4-L5 level)

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9
Q

What nerve root is likely compressed at this disc herniation at L4-L5?

A

This is a far lateral herniation that would compress the EXITING nerve root at L4-L5, which is L4.

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10
Q

Indications for operative management in lumbar disc hernation?

A

Cauda equina, weakness or failure of conservative management. DO NOT FUSE unless they have instability

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11
Q

Indications for fusion with herniatic lumbar disc

A

Multiple recurrent HNP

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12
Q

Treatment of single recurrent herniated disc?

A

Microdiscectomy without fusion

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13
Q

Outcomes in far lateral disc herniation treated with Wiltse approach

A

Not as well as central disc herniation treatment, persistent radiculopathy in some

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14
Q

How does vascular claudication differ from neurogenic claudication

A

In vascular claudication patients have no pain when standing still, they have pain when walking up a hill (better going uphill in neurogenic, worse going down hill), pain on stationary bike and pain starts in feet (buttock in neurogenic)

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15
Q

Surgical management of lumbar stenosis

A

Don’t need to fuse unless evidence of instability or severe foraminal stenosis that may render the segment unstable with facet resection

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16
Q

SPORT trial for lumbar stenosis

A

Surgery did better than non-op group

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17
Q

Pediatric spondylolysis prognosis

A

If Meyerding grade I or II by skeletal maturity, they do not slip more. Grades III and IV tend to progress.

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18
Q

6 types of spondylolisthesis

A

Dysplastic (presents ages 4-6 w/high grade slip, kyphosis and neurologic sx), isthmic, degenerative, traumatic, pathologic and iatrogenic

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19
Q

Treatment of high grade dysplastic spondylolisthesis in a child?

A

Fusion. Can do L5-S1 in situ fusion which leaves residual deformity, but reduces risk to L5 nerve root with reduction of the slip

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20
Q

When do adolescents with low grade isthmic spondylolysis get nerve compression symptoms?

A

As they age, the disc degenerates and they get “up down” foraminal stenosis

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21
Q

Surgical treatment of adult isthmic spondylolisthesis

A

Interbody fusion improves rates of fusion

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22
Q

Most common level for degenerative spondylolisthesis

A

L4-L5

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23
Q

Cause of degenerative spondylolisthesis

A

Incompetent facet joints lead to spondylolisthesis, compression is usually central or lateral recess

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24
Q

Surgical treatment of degenerative spondylolisthesis

A

Decompression only if <5mm movement on flex-ext views. If unstable, fusion

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25
Q

Most common level for isthmic spondylolisthesis

A

L5-S1

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26
Q

PVR threshold in cauda equina

A

<200cc is not cauda equina, >500 = cauda equina, in between we don’t know

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27
Q

Best study to evaluate recurrent HNP

A

MRI WITH CONTRAST, scar will enhance with contrast, recurrent disc will not light up

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28
Q

Approach with highest risk of nerve root injury in lumbar spine surgery

A

TLIF approach

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29
Q

% of facet to keep to limit instability when not fusing

A

Maintain >50% of both facets

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30
Q

What decreases the risk of pseudoarthrosis after lumbar fusion?

A

Instrumentation

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31
Q

Treatment of post-discectomy diskitis

A

MRI with contrast, if it lights up in the disc, treatment is IR biopsy and medical management

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32
Q

Key physical exam finding to differentiate thoracic myelopathy from cervical myelopathy

A

Thoracic myelopathy will have UMN signs in the lower extremities, but not in the upper extremities like cervical myelopathy

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33
Q

Surgical treatment of thoracic myelopathy

A

May require thoracotomy because you can’t retract to cord at the thoracic level enough to get at the disc space

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34
Q

Indication for operative management of osteodiskitis

A

Impending mechanical/neurological instability, concomitant epidural abscess, unable to get IR biopsy or failure of full medical management

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35
Q

Continue antibiotics while drains in?

A

Not indicated

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36
Q

Most common region of spine involved in metastatic disease

A

Thoracic (70%), lumbar (20%), cervical (10%)

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37
Q

Most commonly involved column in spinal mets?

A

Anterior column

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38
Q

Next step in patients with an intradural spinal mets

A

Brain MRI to look for primary lesion causing drop down mets

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39
Q

Treatment of lymphoma in the spine?

A

Typically non-surgical, it is very radiosensitive

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40
Q

Indications for surgical stabilization of the spine in metastatic disease

A

Cord compression, unrelenting pain despite max treatment, need for open biopsy, mechanical instability and radio-insensitive tumors (renal cell)

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41
Q

Primary tumors of the spine seen in the posterior elements?

A

ABC, osteoid osteoma and osteoblastoma

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42
Q

Operative management of spine ABC

A

En bloc resection may not be possible, may need extended curettage and grafting +/- post op XRT if you can’t get it all (worry is that these can dedifferentiate into sarcoma after XRT)

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43
Q

What is your diagnosis?

A

Hemangioma. The prison bars on the sagittal and polka dots on the axial are characteristic.

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44
Q

Management of vertebral plana in eosinophilic granuloma

A

Bracing to prevent kyphosis, can do low dose XR; however, vertebrae may reconstitute up to 30%

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45
Q

Most common axial site of giant cell tumor?

A

Sacrum, then clivus

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46
Q

Treatment of giant cell tumor in the spine?

A

Excision and bone grafting (has high local recurrence rate), no XRT due to malignant transformation risk

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47
Q

Surgical management of chordoma

A

Resection and reconstruction, no XRT because it is radioresistant

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48
Q

Most common site of thoracolumbar fractures

A

T11-L2 where fixed thoracic spine transitions to flexible lumbar spine

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49
Q

Prognosis of sacral sparing spinal cord injury?

A

Residual sensation around S2-S5 = incomplete cord injury and may get more recovery than a complete ASIA A.

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50
Q

Diagnosis of vertebral compression fractures

A

Anterior column <50% height loss, middle column intact.

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51
Q

Treatment of VCF

A

Nonsurgical, kyphoplasty if fail initial non-op management

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52
Q

Diagnosis of burst fracture

A

Fracture of anterior and middle columns +/- posterior column involvement.

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53
Q

Risk of lamina fracture in burst fracture?

A

Possible dural tear and nerve entrapment (77%), need to be careful during initial approach

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54
Q

Treatment of burst fracture

A

If intact neuro and PLC -> bracing/non-op regardless of retropulsion or vertebral height loss. If neuro deficit, fracture dislocation or PLC injury w/progressive kyphosis -> surgery

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55
Q

ASIA classification

A

A) complete B) sacral sparing C) 50% <3/5 strength D) 50% 3 or more/5 strength E) Normal

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56
Q

Treatment of bony vs. ligamentous chance fracture

A

Bony = brace in extension. Ligamentous = less likely to heal = surgery

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57
Q

Spine GSW antibiotic indications

A

No abdominal injury = PO. Solid organ injury = PO abx. Hollow organ injury = IV abx 7-14 days + tetanus.

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58
Q

Indications for operative management in spine GSWs

A

Abdominal organ injury or progressive neuro deterioration. If bullet is in canal and T12 or above, observe. If below T12 consider removing if residual neuro sx

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59
Q

Spinal cord syndrome with ipsilateral motor loss and contralateral loss of pain and temperature sensation? Prognosis?

A

Brown-Sequard. Best prognosis for ambulation, 99% will regain ambulatory status.

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60
Q

Spinal cord syndrome in elderly with hyperextension and UE involvement > LE.

A

Central cord

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61
Q

Spinal cord syndrome with associated vascular injury, motor loss, proprioception preserved? Prognosis?

A

Anterior cord, seen in large aortic reconstructions. Worst prognosis for ambulation.

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62
Q

Spinal cord syndrome with motor intact and loss of proprioception?

A

Posterior cord syndrome (Tabes dorsalis from syphilis)

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63
Q

Autonomic dysreflexia

A

Thoracic injury above T5 with severe hypertension, flushing, sweating, blurred vision caused by obstructed urinary catheter or fecal impaction. Can also present after an undiagnosed fracture.

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64
Q

Where should the C7 plumb line fall?

A

Center of C7 body line should cross T12/L1 junction and posterior corner of L5-S1. Poor balance becomes an issue when 7cm anterior.

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65
Q

What are lumbar lordosis, sacral slope, pelvic tilit and pelvic incidence? Which value is fixed?

A

Pelvic incidence is a fixed value.

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66
Q

Calculating pelvic incidence

A

PI = SS + PT

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67
Q

LL – PI goal with deformity correction

A

Within 10 degrees of each other

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68
Q

PT goal with deformity correction

A

<25 degrees

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69
Q

SVA target in deformity correction

A

0 in young patients, more in elderly because it can lead to PJK if at 0

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70
Q

Contraindication for Ponte osteotomy

A

Non-mobile disc. Correction in this osteotomy happens through the disc, so it wont work if the disc is degenerative. You must do a PSO or VCO in this group.

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71
Q

What parts are removed in a Ponte osteotomy?

A

½ of the lamina and bilateral superior facets, this will get you 10 degree correction per level

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72
Q

What parts are removed in pedicle subtraction osteotomy?

A

Pedicles and osteotomy converges at anterior cortex of vertebral body. Gets 25-30 degrees correction/level.

73
Q

Percentage of lumbar stenosis patients with tandem stenosis?

A

20% will have cervical myelopathy

74
Q

Definition of congenital stenosis and absolute stenosis?

A

Congenital is <10mm SAC, absolute <8mm SAC

75
Q

Lhermitte’s sign

A

Shock sensations down the back with neck flexion, seen in cervical myelopathy

76
Q

Torg-Pavlov ratio

A

Measurement of vertebral body to spinal canal in cervical spine, if <0.8, then suggests congenital stenosis (blue in picture)

77
Q

Score that helps determine operative timing and outcomes in cervical myelopathy?

A

JOA <14 = poor outcome with operative mangement, consider surgery in patients with scores between 4-14

78
Q

Nurick classification

A

0 = root sx only, 1 = cord compression, normal gait, 2= gait impaired but employed, 3= gait impaired, not employed, walks unassisted, 4 = unable to walk without assistance, 5 = wheelchair bound

79
Q

Predictors of poor outcome in operative management of cervical myelopathy

A

JOA <14 (most important), cord signal change (snake eyes shown below), older age, smoking, medical comorbidities and SAC <13mm

80
Q

Algorithm for operative management of cervical myelopathy

A

Kyphosis >10 degrees needs anterior, 3+ levels needs posterior too. Kyphosis <10 degrees can go anterior or posterior, anterior if 1-2 levels, anterior & posterior or posterior alone if 3+ levels, may also consider laminoplasty in select patients

81
Q

K line

A

Line drawn from top to bottom of decompression. If line intersects vertebral body, there is too much kyphosis and you need to do a decompression and correction from the front.

82
Q

Anterior vs. posterior c-spine surgery comparision

A

Higher rate of infection with posterior surgery, decreased with Vanc powder

83
Q

Anterior or posterior approach preferred for OPLL?

A

Posterior. Anterior has a high risk of complications.

84
Q

Guidelines for corpectomy

A

Okay for anterior alone at 1 level, should back up posterior with 2 levels, because higher risk for graft displacement and pseudoarthrosis

85
Q

Why do you have to back up a 3 level ACDF?

A

Higher risk for pseudoarthrosis with isolated ACDF in 3 or more levels

86
Q

Whats your diagnosis in this patient with visual disturbances and isolated RUE and LLE numbness?

A

MS. Note the focal demyelinating lesions without any adjacent cord compression. This is how you differentiate it from cervical meylopathy.

87
Q

Football player has transient quadriplegia that resolves in minutes. What is the next step?

A

MRI. If he has stenosis then no return to play. If MRI is normal and he has no residual symptoms, he may return to play.

88
Q

What is your diagnosis? What is the associated condition?

A

Basilar invagination, note the dens is now through the foramen magnum. This is associated with RA.

89
Q

What’s your diagnosis? What’s the associated condition

A

Note the stair step deformity of multiple levels of cervical spondylosis seen in RA.

90
Q

Measurements/lines seen in basilar invagination?

A

Ranawat C1-2 index: distance from C2 pedicle to line drawn from anterior to posterior arch. Abnormal < 13mm. MacGregor’s line: tip of dens to line from hard palate to most caudal portion of skull base, >4.5mm abnormal. Chamberlin’s line: tip of dens to line from hard palate to posterior edge of foramen magnum, >5mm abnormal

91
Q

Operative management of basilar invagination

A

Occiput – C2 fusion with traction at time of surgery if able, anterior transoral decompression and posterior fusion if there is brain stem compression

92
Q

Cervical spine measurements when assessing atlantoaxial instability

A

ADI > 3.5mm = instability, >7mm = disrupted alar ligaments, >10mm = surgery indicated. PADI <14mm = indication for surgery. >13mm greatest sign for recovery.

93
Q

Operative management of rheumatoid C1-C2 instability

A

C1-2 fusion with wiring +halo, C-1 transarticular screw, C1-2 Harms or occipute to C2 fusion with posterior arch decompressiona and possible odontoidectomy

94
Q

Indications for operative management in subaxial subluxation in RA

A

Neuro sx, >4mm spondylolisthesis or 20% displacement (higher likelihood for cord compression). Also cervical height/width ratio <2 is 100% specific for predicting neurologic compromise

95
Q

Abatacept mechanism of action

A

MCH receptor antagonist

96
Q

Operative management of subaxial subluxation in RA?

A

Same algorithm as cervical myelopathy

97
Q

50% of cervical flexion/extension comes from what joint

A

Occiput-C1

98
Q

50% of cervical rotation comes from what joint

A

C1-C2

99
Q

Blood supply to cartilaginous disc?

A

No direct blood supply, comes through cartilagenous endplates.

100
Q

C5 reflex

A

Biceps

101
Q

C6 reflex

A

BR

102
Q

C7 reflex

A

Triceps

103
Q

L4 reflex

A

Patellar tendon

104
Q

S1 reflex

A

Achilles

105
Q

What defines instability on c-spine flex/ext views?

A

> 3.5mm translation and/or 11 degrees of angulation across any level

106
Q

% of patients over 40 with asymptomatic herniated cervical disc

A

28%

107
Q

Timing to operate on patients with cervical radiculopathy

A

Non-op management for at least 12 weeks. Only indication to treat early is with progressively worsening weakness.

108
Q

Indications for isolated foraminotomy

A

No neck pain, radiculopathy with soft foraminal disc herniation, normal cervical lordosis

109
Q

Indication for cervical disc replacement

A

No facet arthritis, young patient, single or two level disc disease or foramenal narrowing with radiculopathy or myelopathy, neck pain is a relative contraindication. Benefit is possible decrease in adjacent segment degeneration.

110
Q

Palpable landmarks for C2 – C6

A

C2 = angle of mandible, C3 = hyoid, C4-5 = thyroid, C5-6 = cricoid cartilage 1st ring, C6 = carotid tubercle

111
Q

What innervates the omohyoid?

A

Branches of the ansa cervicalis

112
Q

Main structure at risk when placing screws into the occiput

A

Transverse foramen, screws shouldn’t be longer than 12mm

113
Q

Strongest type of screw to place into C2

A

Pedicle > Translaminar >Pars

114
Q

Management of post-op C5 palsy

A

Only observation. EMG, steroids, foramenotomy are all not indicated, 95% recover spontaneously.

115
Q

Recurrent laryngeal nerve more commonly injured

A

No difference in sides. Left goes around aortic arch, right goes around the subclavian and is more superficial in the approach.

116
Q

How does Horner’s syndrome occur during ACDF?

A

Failure to protect the sympathetic chain on the longus coli, highest risk level is C6

117
Q

How does hypoglossal injury occur during ACDF? What are the clinical signs?

A

C2-3, C3-4 level approach puts the hypoglossal nerve at risk (CN XII). Tongue will deviate to the side of injury

118
Q

Most common cause of post-op airway compromise

A

Hematoma

119
Q

Mortality in patients with mediastinal perforation after ACDF

A

50%

120
Q

Ways to limit post-op dysphagia after ACDF

A

Limit retraction, deflate/reinflate ET tube after retractors are placed, decrease surgical time, steroids, zero profile or no anterior plate

121
Q

Rate of adjacent segment degeneration after ACDF

A

2.6% per year, 20% over 5-10 years

122
Q

Risk factors for adjacent segment degeneration after ACDF?

A

Plate <5mm from adjacent level, smoking and female

123
Q

% of spinal cord injuries associated with poor transfer techniques after injury

A

Up to 25%

124
Q

What embryonic layer does the spinal cord develop from?

A

Ectoderm -> neural tube

125
Q

What anomalies occur when the neural tube fails to close?

A

Proximally= anencephaly. Distallly = spina bifida.

126
Q

What embryonic layer becomes the peripheral nervous system?

A

Neural crest

127
Q

What embryonic layer becomes the vertebral bodies and discs?

A

Notocord, if this fails to form appropriately you can get hemivertebrae and bars.

128
Q

Descending motor tracts

A

Lateral corticospinal tract (main voluntary motot, UE pathways are more central). Ventral corticospinal tract (volunatry motore)

129
Q

Ascending sensory tracts

A

Dorsal column = deep touch, vibration and proprioceptions. Lateral spinothalamic tract = pain and temperature. Ventral spinothalamic tract = light touch.

130
Q

Spinal cord blood supply

A

2/3 comes from the anterior spinal artery, injury results in deficits to the lateral corticospinal and ventral corticospinal tracts. 1/3 comes posterior.

131
Q

Cord levels supplied by Artery of Adamkiewicz

A

In 75% the artery originates on the left from the posterior intercostal branch off the aorta and travels from T8-L1, supplying the lower 2/3 of the spinal cord.

132
Q

Why increase MAPs when patients loose motor signals intra-op?

A

Most common reason is vasospasm of the anterior spinal artery, increasing the MAPs pushes the blood through the vasospasm

133
Q

How do you define the level of injury in spinal cord injury?

A

Ensure the bulbocavernosus reflex is back indicating they are no longer in spinal shock. Then identify the most cephalad level with normal bilateral sensory and motor function

134
Q

Vent dependent level in spinal cord injjry

A

C1-4

135
Q

Vend independent but unable to feed self in spinal cord injury

A

C5

136
Q

Able to feed self, manual wheelchair and drive car level in spinal cord injury

A

C6

137
Q

Level of spinal cord injury that allows use of manual wheelchair and indepence with transfers

A

C7

138
Q

Steroids in spinal cord injury

A

Not indicated

139
Q

Algorithm for timing of operative management in spinal cord injury

A

Incomplete = surgery within 12 hours can save 1-2 functional levels. Complete = surgery within 24 hours. Central cord = typically nonop unless they have severe worsening of symptoms. GSW = typically non-op unless cord compression with incomplete SCI and fragment in canal.

140
Q

Treatment in anterior spinal cord injury from vascular occlusion or ischemia?

A

No intervention, observation is all you can do

141
Q

Incidence of depression in spinal cord injury

A

11%

142
Q

Spinal cord level predisposed to autonomic dysreflexia

A

T6

143
Q

Osteophytes in DISH vs AS

A

DISH = flowing, AS = marginal

144
Q

What’s your diagnosis?

A

DISH, it is associated with massive amounts of right sided thoracic bone formation

145
Q

Operative management of spinal fractures in DISH and AS?

A

Long instrumented fusions and epidural hematoma decompression

146
Q

Imaging work up in trauma patients with DISH and AS

A

Need full spine CT to look for non-contiguous injury

147
Q

How many ossification centers in C1?

A

3, lateral masses fuse at age 7

148
Q

How many ossification centers in C2?

A

5, there is a subdental (basilar) synchondrosis that fuses between 5-7 and can become an os odontoideum if it doesn’t fuse.

149
Q

Why are odontoid fractures prone to non-union?

A

There is a vascular watershed at the waist between the internal carotid and vertebral arteries.

150
Q

Treatment algorithm of ondontoid fractures

A

Type I = tip = collar. Type II = waist, non-op if <50 and/or displaced <6mm and 10 degrees, op if >50 and displaced. Type III = body = collar.

151
Q

Sports clearance in this patient?

A

Patients with an os odontoideum should not be cleared for contact sports

152
Q

Risks for non-union in odontoid fractures

A

Age >5, displacement >6mm. posterior angulation >10 deg, diabetes, delay in treatment

153
Q

Why not treat an odontoid fracture in a halo?

A

40% mortality in patients >65 due to pneumonia, cardiac and respiratory arrest

154
Q

Indications for anterior odontoid screw

A

Type II fracture that is reduced in a patient with good bone, intact transverse ligament and no barrel chest

155
Q

Types of C1 fractures

A

I = isolated arch, II = anterior and posterior arch, III = isolated lateral mass. Treatment depends on if the transverse ligament is intact.

156
Q

Radiographic measurements that indicate an injury to the transverse ligament in C1 fractures

A

Sum of lateral mass displacement >8.1mm

157
Q

ADI and PADI imaging thresholds for transverse ligament injury

A

ADI <3mm (<5mm kids), 3-5mm = transverse ligament injury with apical and alar intact, >5mm = apical, alar and transverse injured

158
Q

Treatment algorithm for C1 fractures

A

Halo or collar if stable (<8.1mm lateral mass displacement on ondontoid view). Occiput -C2 fusion if unstable.

159
Q

Most common fracture associated with facet dislocations

A

Superior facet

160
Q

Spondylolisthesis seen in unilateral vs bilateral facet dislocation

A

Up to 25% if unilateral, 25-50% if bilateral

161
Q

Indications for MRI in cervical facet dislocation? Treatment?

A

Altered mental status, failed closed reduction, neurologic before/deterioration during reduction = MRI. If not reduced, go posterior to reduce/stabilize. If reduced and needs discectomy, go from the front.

162
Q

Injuries associated with vertebral artery injury

A

OCD, transverse foramen fracture, facet dislocation, basilar skull fracture

163
Q

Powers ratio

A

CD/AB. Normal = 1, abnormal = OCD

164
Q

Treatment of OCD fracture dislocation?

A

Occiput to cervical fusion

165
Q

Management of bilateral C2 pars fractures

A

Look for other injuries in c-spine (30%). If <3mm displaced and intact disc with no angulation = collar. If 3-5mm displaced = halo, if >5mm displaced try to reduce w/traction, fi doesn’t reduce = C1-2 maybe 3 PSIF.

166
Q

% of patients with non-continguous spine fracture in subaxial c-spine fractures

A

10-15%

167
Q

Management of flexion vs extension tear drop.

A

Flexion tear drop is unstable, associated with SCI and needs anterior vs. ant/post surgery. The extension tear drop is an ALL ligament avulsion and can be treated in a collar (shown).

168
Q

Management of floating lateral mass in subaxial c-spine injury

A

Needs posterior fusion if needs reduction, can do anterior if already reduced. No indication for non-op because it is unstable.

169
Q

C-spine injuries that should not be treated in a halo

A

Age >50 and subaxial c-spine (bell-ringer phenomenon with increased subaxial motion, poorly controls lateral bending)

170
Q

Contraindications to halo orthosis

A

Cranial fracture, infection, severe soft tissue injury, <2 years old, age >50, chest trauma, obesity

171
Q

Adult halo pin technique

A

4 pins at 8in-lbs. Anterior pin is lateral 2/3’s of orbit and 1cm above supraorbital ridge below the equator. Posterior pin is 180 Degrees from the anterior pin and below the equator.

172
Q

Pediatric halo pin technique

A

8 pins at 4 in-lbs

173
Q

Complications associated with halos

A

Loosening (40%), infection (20%), supra orbital nerve palsy and abducens palsy (CN VI, shown)

174
Q

What do SSEPs monitor

A

Dorsal sensory column. The UE or LE is stimulated and transcranial leads from the somatosensory cortex record a response.

175
Q

SSEP or MEP less variable with anesthetic?

A

SSEP. Anesthetic gas can make MEPs less reliable

176
Q

Cons of SSEPs

A

Not as reliable and slower to respond to injury. MEPs detect ischemic or other injury to the anterior cord.

177
Q

SSEP alert levels? MEP alert levels?

A

50% decrease in amplitude and/or 10% decreased latency. >75% decrease in amplitude for MEPs.

178
Q

What do MEPs monitor?

A

Lateral and ventral motor tracts. Transcranial stimulation of motor cortex, measures response in muscle contraction.

Spine (1 decks)

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