Types of IONM  Continuous or signalled  INITIATION  UE: median or ulnar  LE: post tib nerve or peroneal nerve  RECORDING   Transcranial somatosensory cortex  Can use with NM blockade (not sensitive to anesthesia)  Advantages  Reliable, unaffected by anesthetics  Disadvantages  Nerve roots not checked  Delay due to summation  Tests  Dorsal Columns  Loss if:  Impacts dorsal column  Motor EvokedContinue reading “Neuromonitoring “

Subaxial PSD Dr. Ahn  

Clinical Note:  Dx: Cervical Myelopathy secondary to Spinal Stenosis at C56  Procedure: C56 Decompression only no fusion  Preop:  Cefazolin IV 1g  Decadron 10mg IV  Equipment:  Ziehm fluoroscopy  Jackson with bolsters  Positioning:  1.) Jackson with bolsters  2.) Gentle log roll  3.) face on donut neutral flex-ex  4.)  

Ahn Lumbar DC and Fusion  

Consent forms were signed.  Risks and benefits of  surgery were discussed both with her and her son who is present.  Certainly  risks included, but are not limited to infection, especially with rheumatoid  disease, misplaced screws or screws that pullout, especially considering her  rheumatoid disease and potentially soft bone.  Other risks certainly include  dural tears, which isContinue reading “Ahn Lumbar DC and Fusion  “

Ahn o-T1  

The patient was brought into the Operating Room.  Anesthesia had seen the  patient.  Preop Decadron was administered 10 mg IV for stress dosing.  She received preoperative 2 g of IV Ancef along with Cipro for wound prophylaxis  and UTI prophylaxis.  She then got a general anesthetic with awake fiberoptic intubation.  Once  asleep, she was thenContinue reading “Ahn o-T1  “

Lumbar Microdisc Dr. Ahn 

Indications  Complications  We discussed the  risks, complications, benefits and alternatives of the intervention with him,  which would be a right L4-L5 microdiskectomy.  These include but are not limited  to, injury to the nerve root, injury to the dural sac causing CSF leak requiring  repair, infection, instability of the spine, stiffness, ongoing pain and  discomfort, medical complications from theContinue reading “Lumbar Microdisc Dr. Ahn “

PCDF Dr. Ahn  

Indications  Myelopathy  ACDF vs PCDF algorithm    Complications    Preop Imaging    Equipment  Jackson Table with Frame  Stryker Navigation Machine  C Arm Large  Large Zelpis  Stryker Oasys (  Headlight & Loupes (Approach)  Microscope (Decompression)  Position  Surgical pause  Move patient to Jackson Supine  Intubate/ Arterial Line/ Foley  Pneumatic TEDS on  Pillows over shins  Mayfields  Loosen to maxContinue reading “PCDF Dr. Ahn  “

ACDF Dr. Ahn  

Complications  Dysphagia  Usually short term that resolves in 1 months up to 50%  Dysphonia  RLN – hoarseness 5-6%  Pseudarthrosis  Implant failure  Neurologic injury  Airway compromise  ASD – 3%  Preop Imaging  CT  Is there OPLL?  Spurs?  Calcified Disc?  MRI   Level of compression  Nerve Roots Free?  Vertebral Artery position -5% are aberrant (sometimes TF is within theContinue reading “ACDF Dr. Ahn  “