Electrophysiological Monitoring during Routine Spinal Surgery
Intraoperative electrophysiological monitoring during spinal surgery may assist in diagnosing neurological injury. However, there is no evidence that such monitoring either (1) reduces the incidence of neurological injury or (2) mitigates the severity of it. Intraoperative electrophysiological monitoring should be performed if the diagnostic information gained is of value, particularly in high risk cases such as deformity, gross instability, navigation through or around peripheral nerves, or intramedullary procedures. The routine use of intraoperative electrophysiological monitoring is neither warranted nor recommended.
Read a thoughtful critique to the Deyo JAMA article . This article has identified a potential trend towards the application of more complex fusion procedures to Medicare patients who are treated with fusion as an adjunct to decompressive procedures for lumbar stenosis. However, without a clear understanding of patient selection criteria, outcomes achieved, and risk stratification, over-interpretation of such data is potentially misleading and dangerous.
Thoracic spinal surgery and peripheral nerve surgery, including
sympathectomy, are traditional and integral components of neurosurgical
training and practice. Video-assisted thoracic surgery (VATS) of the spine
is a minimally invasive technique performed by neurosurgeons for conditions
traditionally treated by neurosurgery. These conditions include thoracic
sympathectomy for hyperhydrosis, upper extremity complex regional pain
syndromes, and thoracic spinal surgery for thoracic disc herniation, spinal
tumor, spinal instability, and scoliotic deformity.
Neurosurgeons currently in training receive experience in VATS during
residency and are examined for competency in the procedure and its
indications by the American Board of Neurological Surgery. Neurosurgical
residency programs provide opportunity for training in minimally invasive
neurosurgical techniques, including VATS for sympathectomy and spinal disorders.
Purpose of the Spine and Peripheral Nerves Section
Nov 26, 2006
To foster the use of spinal neurosurgical methods for the treatment of
diseases of the spinal neural elements, the spine and peripheral nerves.
To advance spinal neurosurgery and related sciences, to improve patient
care, to support meaningful basic and clinical research, to provide leadership
in undergraduate and graduate continuing education, and to promote administrative
facilities necessary to achieve these goals.
Founders: The Section on Disorders
of the Spine and Peripheral Nerves was founded at the suggestion of Albert
L. Rhoton, MD in 1978 to Charles Drake, MD, President of the AANS in 1978.
Also instrumental were Stewart B. Dunsker, MD and Russell Travis, MD.