Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials.

Stanley A Skinner, Brian Hsu, Ensor E Transfeldt, Amir A Mehbod, David M Rippe, Chunhui Wu, Serkan Erkan

Journal of clinical monitoring and computing 2013 Apr

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We have previously investigated electromyographic (EMG) and transcranial motor evoked potential (MEP) abnormalities after mechanical spinal cord injury. We now report thermally generated porcine spinal cord injury, characterized by spinal cord generated hindlimb EMG injury activity and spinal cord motor conduction block (MEP loss). Electrocautery (EC) was delivered to thoracic level dural root sleeves within 6-8 mm of the spinal cord (n = 6). Temperature recordings were made near the spinal cord. EMG and MEP were recorded by multiple gluteobiceps intramuscular electrodes before, during, and after EC. Duration of EC was titrated to an end-point of spinal motor conduction block (MEP loss). In 5/6 roots, ipsilateral EMG injury activity was induced by EC. In 4/5 roots, EMG injury activity was identified before MEP loss. In all roots, a minimum of 20 s EC and a temperature maximum of at least 57 °C at the dural root sleeve were required to induce MEP loss. Unexpectedly, conduction block was preceded by an enhanced MEP in 4/6 trials. EMG injury activity, preceding MEP loss, can be seen during near spinal cord EC. Depolarization and facilitation of lumbar motor neurons by thermally excited descending spinal tracts likely explains both hindlimb EMG and an enhanced MEP signal (seen before conduction block) respectively. A thermal mechanism may play a role in some unexplained MEP losses during intraoperative monitoring. EMG recordings might help to detect abnormal discharges and forewarn the monitorist during both mechanical and thermal injury to the spinal cord.

Citation

Stanley A Skinner, Brian Hsu, Ensor E Transfeldt, Amir A Mehbod, David M Rippe, Chunhui Wu, Serkan Erkan. Spinal cord injury from electrocautery: observations in a porcine model using electromyography and motor evoked potentials. Journal of clinical monitoring and computing. 2013 Apr;27(2):195-201