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Neurology, Neurologie, Orthopedics traumatology, Orthopédie, traumatologie, Sciences biologiques et medicales, Biological and medical sciences, Sciences medicales, Medical sciences, Neurologie, Neurology, Système nerveux (sémiologie, syndromes), Nervous system (semeiology, syndromes), Liquide céphalorachidien. Méninges. Moelle épinière, Cerebrospinal fluid. Meninges. Spinal cord, Radiotherapie. Traitement instrumental. Physiotherapie. Reeducation. Readaptation, orthophonie, crenotherapie. Traitement dietetique et traitements divers (generalites), Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects), Maladies de l'appareil respiratoire, Diseases of the respiratory system, Déformation, Deformation, Deformación, Electrophysiologie, Electrophysiology, Electrofisiología, Pathologie du rachis, Spine disease, Raquis patología, Pathologie du système nerveux central, Central nervous system disease, Sistema nervosio central patología, Pathologie du système ostéoarticulaire, Diseases of the osteoarticular system, Sistema osteoarticular patología, Système ostéoarticulaire, Osteoarticular system, Sistema osteoarticular, Canal rachidien, Vertebral canal, Canal vertebral, Circuit déclenchement, Trigger, Circuito desenganche, Electromyographie, Electromyography, Electromiografía, Etude comparative, Comparative study, Estudio comparativo, Pathologie de la moelle épinière, Spinal cord disease, Médula espinal patología, Pathologie du système nerveux, Nervous system diseases, Sistema nervioso patología, Rachis, Spine, Raquis, Scoliose, Scoliosis, Escoliosis, Vis, Screw, Tornillo, IOM, pedicle screw, scoliosis, and triggered electromyography

Study Design. Clinical trial. Objective. To compare the efficacy of a commercially available stimulating pedicle probe with a custom-made probe for the detection of pedicle wall breaches during screw insertion for the surgical correction of scoliosis. Summary of Background Data. Stimulus triggered electromyography has been used to detect small breaches in the walls of the spinal pedicles during pedicle screw insertion. We routinely use a reusable, custom-made clip that can be attached to the screw, pedicle probe, or other instruments. Commercial systems are available in which the instrument is electrically instrumented to deliver current. Methods. In five patients (173 pairs of tests), we compared the threshold current required to trigger an electromyographic response during testing of the pedicle. Each track or screw was tested with both the custom-made and the commercial probe and the threshold current recorded. Results. Both systems were able to detect pedicle wall breaches using triggered electromyography. The threshold current recorded was not significantly different between the two systems (P > 0.1, paired t test) nor was the difference (0.16 mA) clinically significant. Conclusion. No difference was found between the thresholds detected with either system. There is however, a significant difference in the costs of the two probe systems.

Neurology, Neurologie, Sciences biologiques et medicales, Biological and medical sciences, Sciences medicales, Medical sciences, Neurologie, Neurology, Mouvement involontaire, Involuntary movement, Movimiento involuntario, Système nerveux central, Central nervous system, Sistema nervioso central, Trouble neurologique, Neurological disorder, Trastorno neurológico, Générateur, Generator, Generador, Moelle épinière, Spinal cord, Médula espinal, Système nerveux pathologie, Nervous system diseases, Sistema nervioso patología, Tremblement, Tremor, and Temblor

Primary orthostatic tremor is characterized by 16-Hz motor activity that is coherent between muscles. It has been suggested that this tremor originates in the brain. This view is questioned by findings from a patient with complete paraplegia who experiences intermittent leg spasms at rest. The EMG activity within the spasms showed a 16-Hz component that was coherent between muscles unilaterally and bilaterally. This raises the possibility that the spinal cord could be the source of orthostatic tremor.

Summary: Using a previously described technique that measures the "velocity" of the upswing of the median nerve SSEP, we identified an ischemic event during a carotid surgery that did not meet traditional alarm criteria. Mechanical thrombectomy successfully removed a thrombus, and the patient experienced a good recovery. Analysis of the SSEP waveform may allow for the detection of events missed with traditional alarm criteria.
(Copyright © 2021 by the American Clinical Neurophysiology Society.)

Adolescent, Anesthesia statistics numerical data, Child, Electric Stimulation instrumentation, Electric Stimulation methods, Electroencephalography, Extremities physiology, Humans, Motor Cortex physiology, Motor Neurons physiology, Retrospective Studies, Scoliosis etiology, Scoliosis surgery, Spinal Fusion methods, Spinal Muscular Atrophies of Childhood complications, Evoked Potentials, Motor physiology, Extremities physiopathology, Motor Cortex physiopathology, and Spinal Muscular Atrophies of Childhood physiopathology

Spinal muscular atrophy is a progressive condition in which movement is gradually lost as a result of the loss of spinal motor neurons. Individuals with this condition may require surgical correction of a secondary scoliosis. Motor evoked potentials were recorded using transcranial electrical stimulation in four such individuals undergoing surgery. All the patients were nonambulatory and in wheelchairs. Motor evoked potentials were recordable in both upper and lower limb muscles, with similar stimulation parameters to control subjects undergoing surgery for idiopathic scoliosis. The amplitudes of the motor evoked potentials were similar to those in control subjects, although the latencies were shorter reflective of the smaller stature of the spinal muscular atrophy patients. The relative preservation of the motor evoked potentials despite the patients' poor voluntary motor control suggests that there is a selective preservation of the motor neurons mediating the motor evoked potential in spinal muscular atrophy and a maintenance of the conduction velocities of the corticospinal tract.