San-Juan Daniel, Diaz-Martinez Rafael, Alcocer-Barradas Victor, Alberto Ortega-Porcayo Luis, Amparo Osuna-Zazueta Marcela, Fernanda Tejada-Pineda Maria
Epilepsy Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Clinical Neurophysiology Department, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
Clin Neurophysiol Pract. 2024 Oct 28;9:261-265. doi: 10.1016/j.cnp.2024.10.003. eCollection 2024.
Intraoperative neurophysiological monitoring (IONM) is a highly valuable tool in spinal surgery. It allows for real-time evaluation of nervous system function and alerts the surgeon to any warning signs. Among the various techniques used are motor evoked potentials (MEPs) through transcranial electrical stimulation, which involve applying an electrical stimulus to the scalp in the primary motor cortex region and recording it in the corresponding muscles of the corticospinal tract. There are relative contraindications for this technique, such as in patients who have an implantable device. There is no consensus on how to perform this technique in patients with a deep brain stimulator. We present the case of a 61-year-old patient with Parkinson's disease and a deep brain stimulator (DBS), and who underwent spinal surgery for lumbar discopathy. IONM was performed during the procedure using MEPs, necessitating the deactivation of the DBS to protect its function. Upon completion of the surgical procedure, the device was reactivated, confirming its proper function. We demonstrate that this technique can be safe for these patients, weighing the potential risks and benefits. However, it will be necessary to develop specific guidelines for performing these techniques in the future.
术中神经生理监测（IONM）是脊柱手术中一项极具价值的工具。它能够对神经系统功能进行实时评估，并向外科医生发出任何警示信号。所使用的各种技术中包括通过经颅电刺激的运动诱发电位（MEP），这涉及在初级运动皮层区域向头皮施加电刺激，并在皮质脊髓束的相应肌肉中进行记录。该技术存在相对禁忌证，例如有植入式装置的患者。对于如何在有脑深部电刺激器的患者中实施该技术尚无共识。我们报告一例61岁患有帕金森病且有脑深部电刺激器（DBS）的患者，该患者因腰椎间盘病变接受了脊柱手术。术中使用MEP进行IONM，需要停用DBS以保护其功能。手术完成后，该装置重新激活，确认其功能正常。我们证明，权衡潜在风险和益处后，该技术对这些患者可能是安全的。然而，未来有必要制定实施这些技术的具体指南。
