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- W2327556469 abstract "INTRODUCTION: Intraoperative neurophysiological mapping has been shown to facilitate placement of spinal cord stimulators (SCS) under general anesthesia. While several techniques are effective in predicting laterality of stimulation effect, no study has described a technique for predicting postoperative paresthesias in the feet. Mapping using stimulator triggered electromyography (stimTrEMG) uses responses elicited in specific myotomes to predict corresponding dermatomal paresthesias. Another mapping technique utilizes SCS collision interference with ascending somatosensory signals (SSEP) to verify activation of dorsal column fibers corresponding to the sensory distribution of a peripheral nerve. In this study we compared collision testing and stimTrEMG for predicting SCS-triggered paresthesias in the foot/ankle. METHODS: The records of 12 patients were reviewed retrospectively following placement of a thoracic SCS under general anesthesia. Each patient was tested intraoperatively using both stimTrEMG and collision of posterior tibial nerve (PTN) SSEPs. The distal extent of stimTrEMG activation and the presence of SSEP collision were compared with patient reports of foot/ankle paresthesias during stimulator programming postoperatively. RESULTS: Paresthesias in the foot/ankle were noted for 13 of 19 (73%) tested SCS sites (electrode pairs) in 12 patients. StimTrEMG elicited responses from the distal leg at 3/19 sites, only 2 of which were associated with foot/ankle paresthesias. The sensitivity of stimTrEMG for prediction of distal paresthesias was 15%, while the specificity was 83%. By comparison, positive collision was noted at 11/19 sites, all of which were associated with postoperative foot/ankle paresthesias. The sensitivity of collision testing for prediction of distal paresthesias was 85%, while the specificity was 100%. CONCLUSION: Positive PTN SSEP collision tests appear correlated with postoperative ankle/foot paresthesias. While patients may experience ankle/foot paresthesias even when stimTrEMG activation does not include the foot or lower leg, the sensitivity for this prediction may be low." @default.
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- W2327556469 date "2013-08-01" @default.
- W2327556469 modified "2023-09-27" @default.
- W2327556469 title "172 Use of Intraoperative Collision Testing vs Electromyography for Predicting Postoperative Foot Paresthesias During Spinal Cord Stimulation" @default.
- W2327556469 doi "https://doi.org/10.1227/01.neu.0000432763.74987.65" @default.
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