Somatosensory Evoked Potentials (SSEP) - Revision history

Wdoyon: /* Intraoperative Monitoring */

2024-10-04T01:47:29Z

Intraoperative Monitoring

← Older revision		Revision as of 20:47, 3 October 2024
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	As mentioned above, the lower extremity somatosensory evoked potentials are typically monitored via the posterior tibial nerve. The tibial nerve is a major component of the sciatic nerve and originates from the L4-S3 spinal nerve roots. The tibial nerve provides sensory information from the posterolateral leg, lateral foot and the bottom of the foot.		As mentioned above, the lower extremity somatosensory evoked potentials are typically monitored via the posterior tibial nerve. The tibial nerve is a major component of the sciatic nerve and originates from the L4-S3 spinal nerve roots. The tibial nerve provides sensory information from the posterolateral leg, lateral foot and the bottom of the foot.

	Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral approach ~~itself as well as retractor related~~ nerve compression. The femoral nerve is the major branch of the lumbar plexus and originates from the L2-4 spinal nerve roots~~. The~~ saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve ~~can be found between~~ the vastus medialis and sartorius on the medial part of the thigh. ~~Because it is surrounded by these large muscles and is not superficial~~, it is ~~best~~ to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses ~~should~~ be shorter in latency compared to posterior tibial nerve SSEPs.		Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral angle of the approach and because of nerve compression from the retractors. The femoral nerve is the major branch of the lumbar plexus and originates from the L2-4 spinal nerve roots; and the saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve is not superficial and is surrounded by the vastus medialis and sartorius on the medial part of the thigh. Therefore, it is advised to use needle electrodes for deeper stimulation through the tissue. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses are likely to be shorter in latency compared to posterior tibial nerve SSEPs.

	Superficial peroneal nerve SSEPs have been used to monitor lower lumbar nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.). The superficial peroneal nerve is one of two branches of the common peroneal nerve and originates from the L4-S1 spinal nerve roots. The superficial peroneal nerve provides sensory innervation from the anterolateral aspect of the lower leg and foot. Yue and Martinez showed that superficial peroneal nerve SSEPs were more sensitive than posterior tibial nerve SSEPs at detecting L4-5 nerve root dysfunction.		Superficial peroneal nerve SSEPs have been used to monitor lower lumbar nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.). The superficial peroneal nerve is one of two branches of the common peroneal nerve and originates from the L4-S1 spinal nerve roots. The superficial peroneal nerve provides sensory innervation from the anterolateral aspect of the lower leg and foot. Yue and Martinez showed that superficial peroneal nerve SSEPs were more sensitive than posterior tibial nerve SSEPs at detecting L4-5 nerve root dysfunction.

Wdoyon: /* Intraoperative Monitoring */

2024-09-18T18:13:09Z

Intraoperative Monitoring

← Older revision		Revision as of 13:13, 18 September 2024
Line 63:		Line 63:
	Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral approach itself as well as retractor related nerve compression. The femoral nerve is the major branch of the lumbar plexus and originates from the L2-4 spinal nerve roots. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and is not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.		Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral approach itself as well as retractor related nerve compression. The femoral nerve is the major branch of the lumbar plexus and originates from the L2-4 spinal nerve roots. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and is not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.

	Superficial peroneal nerve SSEPs have been used to monitor lower lumbar nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.). The superficial peroneal nerve is one of two branches of the common peroneal nerve and originates from the L4-S1 spinal nerve roots. The superficial peroneal nerve provides sensory innervation from the anterolateral aspect of the lower leg and foot.		Superficial peroneal nerve SSEPs have been used to monitor lower lumbar nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.). The superficial peroneal nerve is one of two branches of the common peroneal nerve and originates from the L4-S1 spinal nerve roots. The superficial peroneal nerve provides sensory innervation from the anterolateral aspect of the lower leg and foot. Yue and Martinez showed that superficial peroneal nerve SSEPs were more sensitive than posterior tibial nerve SSEPs at detecting L4-5 nerve root dysfunction.

Wdoyon: /* Intraoperative Monitoring */

2024-09-18T18:09:44Z

Intraoperative Monitoring

← Older revision		Revision as of 13:09, 18 September 2024
Line 58:		Line 58:
	Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.		Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.
	#'''Peripheral nerve and plexus.'''		#'''Peripheral nerve and plexus.'''
	Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral approach itself as well as retractor related nerve compression. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and is not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.

	Superficial peroneal nerve SSEPs have been used to monitor lower lumbar nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.). The superficial peroneal nerve is one of two branches of the common peroneal nerve and ~~exits the spine at~~ the L4-S1 ~~level~~. The superficial peroneal nerve provides sensory innervation to the anterolateral aspect of the lower leg and foot.		As mentioned above, the lower extremity somatosensory evoked potentials are typically monitored via the posterior tibial nerve. The tibial nerve is a major component of the sciatic nerve and originates from the L4-S3 spinal nerve roots. The tibial nerve provides sensory information from the posterolateral leg, lateral foot and the bottom of the foot.

			Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral approach itself as well as retractor related nerve compression. The femoral nerve is the major branch of the lumbar plexus and originates from the L2-4 spinal nerve roots. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and is not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.

			Superficial peroneal nerve SSEPs have been used to monitor lower lumbar nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.). The superficial peroneal nerve is one of two branches of the common peroneal nerve and originates from the L4-S1 spinal nerve roots. The superficial peroneal nerve provides sensory innervation from the anterolateral aspect of the lower leg and foot.

Wdoyon: /* Intraoperative Monitoring */

2024-09-17T23:47:49Z

Intraoperative Monitoring

← Older revision		Revision as of 18:47, 17 September 2024
Line 60:		Line 60:
	Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral approach itself as well as retractor related nerve compression. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and is not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.		Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral approach itself as well as retractor related nerve compression. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and is not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.

	~~Peroneal~~ nerve SSEPs have been used to monitor ~~L4-5~~ nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.).		Superficial peroneal nerve SSEPs have been used to monitor lower lumbar nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.). The superficial peroneal nerve is one of two branches of the common peroneal nerve and exits the spine at the L4-S1 level. The superficial peroneal nerve provides sensory innervation to the anterolateral aspect of the lower leg and foot.


	#'''Spinal nerve root'''		#'''Spinal nerve root'''

Wdoyon: /* Intraoperative Monitoring */

2024-09-17T18:04:29Z

Intraoperative Monitoring

← Older revision		Revision as of 13:04, 17 September 2024
Line 58:		Line 58:
	Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.		Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.
	#'''Peripheral nerve and plexus.'''		#'''Peripheral nerve and plexus.'''
	~~For example, saphenous~~ nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions. The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach~~, which is due to~~ the approach itself as well as retractor related nerve ~~damage~~. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.		Saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions (Silverstein et al., 2014; Spine). The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach because of the lateral approach itself as well as retractor related nerve compression. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and is not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.

			Peroneal nerve SSEPs have been used to monitor L4-5 nerve root dysfunction during L4-5 lumbar decompressions (Yue and Martinez, Spine J.).

	#'''Spinal nerve root'''		#'''Spinal nerve root'''
	#'''Spinal cord'''		#'''Spinal cord'''

Wdoyon: /* Intraoperative Monitoring */

2024-09-16T16:43:34Z

Intraoperative Monitoring

← Older revision		Revision as of 11:43, 16 September 2024
Line 57:		Line 57:

	Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.		Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.
	#'''Peripheral nerve and plexus.''' For example, saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions. The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach, which is due to the approach itself as well as retractor related nerve damage. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.		#'''Peripheral nerve and plexus.'''
			For example, saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions. The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach, which is due to the approach itself as well as retractor related nerve damage. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.
	#'''Spinal nerve root'''		#'''Spinal nerve root'''
	#'''Spinal cord'''		#'''Spinal cord'''

Wdoyon: /* Intraoperative Monitoring */

2024-09-16T16:42:55Z

Intraoperative Monitoring

← Older revision		Revision as of 11:42, 16 September 2024
Line 57:		Line 57:

	Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.		Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.
	#'''Peripheral nerve and plexus''' For example, saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions. The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach, which is due to the approach itself as well as retractor related nerve damage. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.		#'''Peripheral nerve and plexus.''' For example, saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions. The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach, which is due to the approach itself as well as retractor related nerve damage. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.
	#'''Spinal nerve root'''		#'''Spinal nerve root'''
	#'''Spinal cord'''		#'''Spinal cord'''

Wdoyon: /* Intraoperative Monitoring */

2024-09-16T16:42:36Z

Intraoperative Monitoring

← Older revision		Revision as of 11:42, 16 September 2024
Line 57:		Line 57:

	Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.		Depending on the specific surgery, planning is required to monitor the part of the nervous system at risk.
	#'''Peripheral nerve and plexus'''		#'''Peripheral nerve and plexus''' For example, saphenous nerve SSEPs are useful for monitoring the femoral nerve during transpsoas (lateral) lumbar fusions. The femoral nerve and lumbar plexus are at risk for injury with the transpsoas approach, which is due to the approach itself as well as retractor related nerve damage. The femoral nerve is the major branch of the lumbar plexus and exits at the L2-4 level. The saphenous nerve is a sensory branch of the femoral nerve and innervates the medial side of the leg and foot. The saphenous nerve can be found between the vastus medialis and sartorius on the medial part of the thigh. Because it is surrounded by these large muscles and not superficial, it is best to use needle electrodes for stimulation. Higher current intensities and pulse durations relative to posterior tibial nerve SSEPs may be required for a good signal to noise ratio. The cortical responses should be shorter in latency compared to posterior tibial nerve SSEPs.
	#'''Spinal nerve root'''		#'''Spinal nerve root'''
	#'''Spinal cord'''		#'''Spinal cord'''

Wdoyon: /* Systemic and Anesthesia Factors */

2022-01-19T03:10:10Z

Systemic and Anesthesia Factors

← Older revision		Revision as of 22:10, 18 January 2022
Line 64:		Line 64:

	== Systemic and Anesthesia Factors ==		== Systemic and Anesthesia Factors ==
	#'''Temperature'''. The temperature of the patient can increase or decrease ~~the latency of the~~ SSEP but does not necessarily affect amplitudes.		#'''Temperature'''. The temperature of the patient can increase or decrease SSEP latencies but does not necessarily affect amplitudes.
	#'''Blood pressure'''. An intraoperative decline in blood pressure is associated with a loss in SSEP signals.		#'''Blood pressure'''. An intraoperative decline in blood pressure is associated with a loss in SSEP signals.
	#'''Halogenated inhalational agents'''. Higher levels of gas anesthesia (> Half MAC) can increase SSEP ~~latency~~ and reduce SSEP amplitudes.		#'''Halogenated inhalational agents'''. Higher levels of gas anesthesia (> Half MAC) can increase SSEP latencies and reduce SSEP amplitudes.
	#'''Nitrous oxide'''. Nitrous oxide decreases SSEP amplitudes but has no effect on ~~latency~~.		#'''Nitrous oxide'''. Nitrous oxide decreases SSEP amplitudes but has no effect on latencies.
	#'''Intravenous analgesic agents'''		#'''Intravenous analgesic agents'''. Intravenous anesthetics, such as propofol, do significantly influence SSEP latencies or amplitudes.
	#'''Muscle relaxants'''. Neuromuscular blockers do not influence SSEP ~~latency~~ or amplitudes.		#'''Muscle relaxants'''. Neuromuscular blockers do not influence SSEP latencies or amplitudes.

	==References==		==References==

Wdoyon: /* Systemic and Anesthesia Factors */

2022-01-19T03:07:34Z

Systemic and Anesthesia Factors

← Older revision		Revision as of 22:07, 18 January 2022
Line 64:		Line 64:

	== Systemic and Anesthesia Factors ==		== Systemic and Anesthesia Factors ==
	#'''Temperature'''. The temperature of the patient can increase or decrease the latency of the SSEP, but does not necessarily affect ~~amplitude~~.		#'''Temperature'''. The temperature of the patient can increase or decrease the latency of the SSEP but does not necessarily affect amplitudes.
	#'''Blood pressure'''. An intraoperative decline in blood pressure is associated with a loss in SSEP signals.		#'''Blood pressure'''. An intraoperative decline in blood pressure is associated with a loss in SSEP signals.
	#'''Halogenated inhalational agents'''		#'''Halogenated inhalational agents'''. Higher levels of gas anesthesia (> Half MAC) can increase SSEP latency and reduce SSEP amplitudes.
	#'''Nitrous oxide'''		#'''Nitrous oxide'''. Nitrous oxide decreases SSEP amplitudes but has no effect on latency.
	#'''Intravenous analgesic agents'''		#'''Intravenous analgesic agents'''
	#'''Muscle relaxants'''		#'''Muscle relaxants'''. Neuromuscular blockers do not influence SSEP latency or amplitudes.

	==References==		==References==