Neurophysiological Research Articles

ОСОБЛИВОСТІ МЕТОДОЛОГІЧНОГО ПІДХОДУ ДО ВИКЛАДАННЯ КУРСУ ФІЗІОЛОГІЇ З ВИКОРИСТАННЯМ КОМП`ЮТЕРНОЇ СИМУЛЯЦІЇ В СИСТЕМІ СУЧАСНОЇ МЕДИЧНОЇ ОСВІТИ В УКРАЇНІ

Мета дослідження – огляд сучасних засобів комп’ютерної симуляції фізіологічних функцій та оцінка і досвід впровадження цих технологій у навчальний процес кафедри фізіології ДЗ “Дніпропетровська медична академія МОЗ України” м. Дніпро.Матеріали та методи дослідження. Теоретичний та методологічний аналіз сучасних симуляційних технологій, які використовуються для викладання курсу фізіології, зокрема програмне забезпечення: “Віртуальна фізіологія” (LuPraFi-Sim, програма представлена Міжнародною спілкою гуманної освіти – InterNICHE, та за підтримки WSPA), Sim Nerv, Six Second ECG. Дескриптивний аналіз якості складання ліцензійного тестового іспиту “Крок-1” за фахом “Стоматологія” вітчизняними студентами у 2017р.Результати й обговорення. На сьогодні доступні та успішно впроваджені у викладання курсу фізіології програми-симулятори з таких розділів, як: фізіологія збудливих структур, центральна та периферична нервова система, автономна нервова система, гуморальна регуляція вісцеральних функцій, система виділення, дихальна система, кров, фізіологія шлунково-кишкового тракту та харчування, серцево-судинна система. За результатами складання ліцензійного тестового іспиту “Крок-1” за фахом “Стоматологія” вітчизняними студентами у 2017 р. середній результат із дисципліни “Фізіологія” складає 74,9 %, при загальному середньому балі по іспиту 72,5 %.Висновки. 1. Нові розробки програмного забезпечення, у яких об’єднані текстова інформація, графіка, відео та анімація фізіологічних процесів, а також можливості впливати на їх перебіг, дають змогу якісного засвоєння теоретичної інформації та більш успішної інтеграції студента до клінічних дисциплін. 2. Згадані розробки активно реалізуються у всіх розділах курсу фізіології й орієнтовані на безперервність і послідовність навчання, основані на історичному досвіді та гуманістичних цінностях, розвитку нових педагогічних технологій. 3. Використання сучасних симуляційних технологій у викладанні курсу фізіології чинить позитивний вплив на якісну успішність студентів при складанні ліцензійного тестового екзамену “Крок-1”.

Application of electrophysiological test in prediabetic peripheral neuropathy

Early diagnosis of prediabetic peripheral neuropathy depends on the evaluation of small fibers. Traditional nerve conduction tests can only evaluate the function of large myelinated fibers, while lack of sensitivity to small fibrous lesions. These lesions were related to pain and autonomic neuropathy. In recent years, with the progress of neurophysiological diagnosis technology, the early diagnosis of diabetic peripheral neuropathy has been improved. Clinical methods, commonly used in the detection of small fibrous lesions, mainly include skin sympathetic response, quantitative sensory test, contact heat pain evoked potential, and quantitative sudomotor axonal reflex test. In this paper, the pathogenesis of diabetic peripheral neuropathy, neurological pathological changes and applications of electrophysiology technology were reviewed to provide an objective basis for early diagnosis of prediabetic peripheral neuropathy. Key words: Electrophysiological test; Prediabetes; Peripheral neuropathy

Extensive alterations of blood metabolites in pediatric cerebral malaria.

Cerebral malaria (CM) presents as an encephalopathy and is due to infection with Plasmodium falciparum. Patients are comatose, often with fever, recurrent seizures and this condition is associated with a high mortality rate. The etiology of the coma and seizures are poorly understood. Circulating small molecules and lipids have bioactive functions and alterations in their concentrations have been implicated in seizure disorders and other forms of encephalopathy. We carried out a comprehensive analysis of blood metabolites during CM to explore a biochemical basis of this encephalopathy. A paired metabolomics analysis was performed on the plasma samples of Malawian children (n = 11) during CM and at convalescence thirty days later, to identify differentially abundant molecules associated with CM. We also report plasma molecules associated with CM mortality (n = 4) compared to survival (n = 19). Plasma metabolites were identified through ultra high performance liquid chromatography/tandem mass spectrometry and gas chromatography/mass spectrometry to maximize compound detection and accuracy and then compared to a library for identification. We detected a total of 432 small molecules in the plasma and 247 metabolites were significantly differentially abundant between CM and convalescence (p < 0.05, FDR < 0.10). These represented global changes across many classes of molecules including lipids, amino acids and hemoglobin metabolites. We observed significant changes in molecules that could impact neurologic function during CM; these include increased levels of kynurenate and decreased indolepropionate, glutamate, arginine and glutamine. Moreover, 1-methylimidazoleacetate, kyurenate, arachidonic acid and dimethylarginine were associated with mortality (p < 0.05, fold change > 1.2). These results highlight the broad changes in blood chemistry during CM. We have identified metabolites that may impact central nervous system physiology and disease outcomes and can be further explored for their mechanistic roles into the pathophysiology of CM.

Glucocorticoid receptor represses brain-derived neurotrophic factor expression in neuron-like cells

Brain-derived neurotrophic factor (BDNF) is involved in many functions such as neuronal growth, survival, synaptic plasticity and memorization. Altered expression levels are associated with many pathological situations such as depression, epilepsy, Alzheimer’s, Huntington’s and Parkinson’s diseases. Glucocorticoid receptor (GR) is also crucial for neuron functions, via binding of glucocorticoid hormones (GCs). GR actions largely overlap those of BDNF. It has been proposed that GR could be a regulator of BDNF expression, however the molecular mechanisms involved have not been clearly defined yet. Herein, we analyzed the effect of a GC agonist dexamethasone (DEX) on BDNF expression in mouse neuronal primary cultures and in the newly characterized, mouse hippocampal BZ cell line established by targeted oncogenesis. Mouse Bdnf gene exhibits a complex genomic structure with 8 untranslated exons (I to VIII) splicing onto one common and unique coding exon IX. We found that DEX significantly downregulated total BDNF mRNA expression by around 30%. Expression of the highly expressed exon IV and VI containing transcripts was also reduced by DEX. The GR antagonist RU486 abolished this effect, which is consistent with specific GR-mediated action. Transient transfection assays allowed us to define a short 275 bp region within exon IV promoter responsible for GR-mediated Bdnf repression. Chromatin immunoprecipitation experiments demonstrated GR recruitment onto this fragment, through unidentified transcription factor tethering. Altogether, GR downregulates Bdnf expression through direct binding to Bdnf regulatory sequences. These findings bring new insights into the crosstalk between GR and BDNF signaling pathways both playing a major role in physiology and pathology of the central nervous system.

Denervation of the extrinsic cardiac sympathetic nervous system as a treatment modality for arrhythmia.

Denervation of the extrinsic cardiac sympathetic nervous system is a method of altering the autonomic tone experienced by the heart and vasculature. It has been studied and employed as a therapy for cardiac disease for decades. Currently, there is a high level of interest in using cardiac denervation for treatment of arrhythmias. This review describes the anatomy and physiology of the cardiac autonomic nervous system followed by a discussion of the mechanistic studies which provide a basis for the therapeutic use of sympathetic denervation. The clinical research supporting its use in human arrhythmias is then appraised, covering the standard indications, such as long QT syndrome, as well as future possibilities. Last, a detailed account of the methods for performing surgical cardiac denervation and percutaneous stellate ganglion anesthetic block is provided, including the complications of each procedure. An understanding of the anatomy and physiology of the cardiac autonomic nervous system along with the techniques of surgical denervation and percutaneous anesthetic block will allow the clinician to effectively discuss and implement these therapies.

Study of event-related potentials on implicit cognitive basis in patients with alcohol dependence

Objective To investigate the event-related potentials(ERPs) characters of implicit cognitive basis in patients with alcohol dependence(AD). Methods Implicit association task and ERPs were detected in 30 individuals with alcohol dependence and 30 controls. Results In patients group, it revealed interaction between picture type and attitude words(F(1, 29)=32.08, P=0.003), and RTs to alcohol-related picture-positive words((653.2±42.3)ms and RTs to non-alcohol-related picture-negative words((698.5±38.1)ms) were faster than those of non-alcohol-related picture-positive words((680.2±40.1)ms) and alcohol-related picture-negative words((713.3±43.3)ms). Additionally, the main effects of picture type and attitude words was significant.RTs to alcohol-related picture were faster than those to non-alcohol-related picture. RTs to alcohol-related picture-positive words in patient group were faster than those of controls((710.0±32.3)ms, P=0.009). In patients group, it revealed interaction between P3 amplitudes for picture type and attitude words.P3 amplitudes to alcohol-related picture-positive words were higher than those of P3 amplitudes to alcohol-related picture-negative words.Interaction among picture type, attitude words and electrode sites was significant in patient group. Conclusions Patients with alcohol dependence present implicit cognitive basis to alcohol related information, and front, front-central and central are neurophysiological architecture. Key words: Alcohol dependence; Implicit cognition; Implicit association task; Event related potentials

P021 Differential clinical and neurophysiological outcomes after premotor rTMS in Parkinson’s disease

Question Weekly sessions of low frequency (LF) repetitive transcranial magnetic stimulation (rTMS) over supplementary motor area (SMA) have shown motor improvement as add-on therapy for Parkinson’s disease (PD). We conducted an active-controlled study to explore potential additive effects of rTMS over both SMA and dorsal premotor area (PMd) compared to SMA alone and potential neurophysiological (NPh) correlates. Methods PD patients with Hoehn & Yahr scores 2–3 participated in a parallel double-blind randomized study of four weekly sessions of LF rTMS. Intervention arms were rTMS over SMA (SMA-alone) and rTMS over both PMd and SMA (PMd + SMA). Clinical outcomes were Unified Parkinson’s Disease Rating Scale-III (UPDRS-III) score; axial, tremor, rigidity, and bradykinesia sub-scores. NPh outcomes were motor evoked potentials, cortical silent period (SP), short interval intra-cortical inhibition and intra-cortical facilitation. Outcomes were analyzed at baseline and 4-weeks post-treatment completion. Results Baseline demographics in Table 1 Figure options Download full-size image Download high-quality image (294 K) Download as PowerPoint slide ; 14 patients completed all study visits. UPDRS-III improved in both arms, SMA-alone (19.8%, p < 0.05) and PMd + SMA (21.0%, p < 0.05). SMA-alone significantly decreased bradykinesia sub-scores (BrS) (z = -2.21, p < 0.05) while PMd + SMA decreased both BrS (z = -2.0, p < 0.05) and axial sub-scores (AxS) (z = -2.4, p < 0.05). NPh outcomes revealed significant increase of SP in PMd + SMA vs. SMA-alone (U = 7.0, p < 0.05). Also, the change in SP showed mod-high correlation with the change in AxS when participants were pooled together (r = -0.60, p < 0.05; Fig. 1 Figure options Download full-size image Download high-quality image (276 K) Download as PowerPoint slide ). Other NPh outcomes were not significant. Conclusions We confirmed weekly LF premotor rTMS can improve motor scores and BrS. AxS improvement seen in the PMd + SMA arm may indicate therapeutic selectivity. As such, the correlation between SP and AxS suggests prolonging SP correlates with improved posture, balance and gait (axial symptoms). As PD patients have shortened SP, this correlation could reflect adequate restorative intra-cortical modulation.

Comparative study of human neuronal and glial cell sensitivity for in vitro neurogenotoxicity testing

Cell cultures from neuronal and glial origin have proven to be powerful tools for elucidating cellular and molecular mechanisms of nervous system development and physiology, and as neurotoxicity models to evaluate in vitro the possible effects of chemicals. But cellular heterogeneity of nervous system is considerable and these cells have been shown to respond diversely to neurotoxic insults, leading to disparate results from different studies. To shed more light on suitability of cellular models of nervous origin for neurotoxicity screening, the objective of this study was to compare the sensitivity to genetic damage induction of two nervous cell lines. To this aim, neurons (SH-SY5Y) and glial (A172) cells were treated with differently-acting genotoxic agents (bleomycin, actinomycin-D, methyl methanesulfonate, mitomycin C, and griseofulvin). After discarding cytotoxicity, genotoxicity was evaluated by a battery of assays encompassing detection of different genetic lesions. Results obtained showed that glial cells are generally more resistant to genotoxic damage induced by clastogenic agents, but more sensitive to aneugenic effects. These results highlight the need of proper design of in vitro neurotoxicology studies, especially for neurogenotoxicity screening, emphasizing the importance of employing more than one nervous cell type for testing the potential toxicity of a particular exposure.

Music and Neurophysiology.

Music and Neurophysiology.

The cerebellum-periaqueductal gray connectivity: a constrained spherical deconvolution tractography study

The periaqueductal gray (PAG) is a relevant neuronal station situated in the midbrain, which play a pivotal role in triggering behavioral responses to stressful stimuli, such as pain or threat. Current knowledge concerning PAG functions is based on several tract-tracing studies conducted on animals, which unveiled PAG connectivity to both cortical and subcortical areas [1]. Considering that descending projections to spinal cord reach the dorsal horn and connections to motor related cortical areas have never been described yet, the neural structure which best fits PAG modulation of motor behavior is the cerebellum. Direct connections between PAG and cerebellar cortex were firstly described in cats and neurophysiological studies conducted on animals, suggesting either direct or undirect PAG influence to cerebellar activity. In the last decades, the rise of diffusion weighted imaging and tractography have made possible to reliably reconstruct white matter pathways in the human brain. To the best of our knowledge, few tractography studies explored PAG connectivity in humans and the evidences concerning direct or undirect connections with the cerebellar cortex are still sparse. Aimed at investigating PAG connectivity with particular focus on PAG-cerebellum connections, we used high quality diffusion weighted imaging data of thirty healthy subjects from the Human Connectome Project. Fiber tracts have been reconstructed using Spherical Informed Filtering of Tractograms, a novel algorithm improving streamline reconstruction and selection [2]. Connectivity analysis revealed that the PAG is mainly connected with subcortical structures, such as the thalamus and the cerebellum. Taken together our results show a direct interplay between the PAG and the cerebellum, thus suggesting the cerebellum as a likely candidate to modulate complex features of motor behavior in stressful conditions, such as adaptation after social defeat and computing strategies to avoid threatening situations.

The evolution of epilepsy surgery.

This review traces the evolution of epilepsy surgery from its early beginnings in the 20th century with the development of neurophysiology, and later the identification of pathology in surgical specimens, to the tremendous boost given by direct brain imaging in the late 20th century. This resulted in the sophisticated methods of presurgical investigation, surgical techniques, and postsurgery care available from the millennium. In parallel, functional surgery, which modifies the nervous system's behaviour, available throughout, has attained a greater place by the use of stimulation.

An 8-week rehabilitation training using the HBP exoskeleton improves cognitive brain functions in multiple sclerosis patients

It has been showed that a single application of the exoskeleton (HBP) in multiple sclerosis patients is able to improve mobility and ambulation. These effects have been associated with brain changes in high-level executive functions decisive for improving patients’ motor control [1]. We applied an 8-weeks rehabilitation protocol in 12 MS patients, half of them randomly assigned to a standard protocol (control group, CG) and the other half to a protocol based on the HBP use (experimental group, EG). Patients were evaluated before and after rehabilitation training using multiple neurological, physiotherapeutic and cognitive testing. During the cognitive task, high-resolution EEG was also recorded for ERP analysis. Results showed that both groups improved their performance in the Barthel, Rivermead, 2-WT, 25-FWT, Tinetti and BBS tests. Only in the EG, other positive treatment effects were observed as measured by the EDSS disability scale and the FSS. Accordingly, in cognitive testing, only the EG showed significant benefits in response time (RT) and accuracy. At brain level the EG showed enhancement in task-related preparatory activity in frontal and prefrontal cortices and stronger post-stimulus activity in the anterior Insula, whose activity is related to more efficient decision making. The CG didn’t show enhanced performance in the cognitive task but only large activity in visual areas, as observed in EG. Concluding, both rehabilitation protocols brought substantial neurophysiological benefits to MS patients, however, the HBP protocol was particularly effective, boosting cognitive functions in prefrontal and frontal brain areas, it allowed improvements in RT and accuracy. The integration of HBP with standard rehabilitation procedure may considerably reduce disability in MS patients.

CD60b: Enriching Neural Stem/Progenitor Cells from Rat Development into Adulthood.

CD60b antigens are highly expressed during development in the rat nervous system, while in the adult their expression is restricted to a few regions, including the subventricular zone (SVZ) around the lateral ventricles—a neurogenic niche in the adult brain. For this reason, we investigated whether the expression of C60b is associated with neural stem/progenitor cells in the SVZ, from development into adulthood. We performed in vitro and in vivo analyses of CD60b expression at different stages and identified the presence of these antigens in neural stem/progenitor cells. We also observed that CD60b could be used to purify and enrich a population of neurosphere-forming cells from the developing and adult brain. We showed that CD60b antigens (mainly corresponding to ganglioside 9-O-acetyl GD3, a well-known molecule expressed during central nervous system development and mainly associated with neuronal migration) are also present in less mature cells and could be used to identify and isolate neural stem/progenitor cells during development and in the adult brain. A better understanding of molecules associated with neurogenesis may contribute not only to improve the knowledge about the physiology of the mammalian central nervous system, but also to find new treatments for regenerating tissue after disease or brain injury.

Cardiolipin in Central Nervous System Physiology and Pathology.

Cardiolipin, an anionic phospholipid found primarily in the inner mitochondrial membrane, has many well-defined roles within the peripheral tissues, including the maintenance of mitochondrial membrane fluidity and the regulation of mitochondrial functions. Within the central nervous system (CNS), cardiolipin is found within both neuronal and non-neuronal glial cells, where it regulates metabolic processes, supports mitochondrial functions, and promotes brain cell viability. Furthermore, cardiolipin has been shown to act as an elimination signal and participate in programmed cell death by apoptosis of both neurons and glia. Since cardiolipin is associated with regulating brain homeostasis, the modification of its structure, or even a decrease in the overall levels of cardiolipin, can result in mitochondrial dysfunction, which is a characteristic feature of many diseases. In this review, we outline the various functions of cardiolipin within the cells of the CNS, including neurons, astrocytes, microglia, and oligodendrocytes. In addition, we discuss the role cardiolipin may play in the pathogenesis of the neurodegenerative disorders Alzheimer's disease and Parkinson's disease, as well as traumatic brain injury.

Application of intraoperative neurophysiological monitoring in cervical intraspinal tumor surgery

Objective To investigate the efficiency of intraoperative neurophysiological monitoring in cervical spinal tumor surgery. Methods Retrospective case-control study comparing 23 cervical spinal tumor patients received surgery under neurophysiological monitoring (case) and 23 cases without neurophysiological monitoring (control). Results All of 46 cases, there were no significant differences of age, gender and preoperative neurological function. Duration of operation and estimated blood loss in the IONM cohort was less than the control group with significant difference. The preoperative JOA score of IONM group and control group were 12.0±2.4 and 12.7±2.1, with no significant difference. The postoperative JOA score of each group were 15.0±1.5 and 15.2±1.7, with no significant difference. The rate of cervical cord neurological improvement of IONM group was higher than control group, but there was no significant difference. In the IONM cohort, abnormal signal appeared in 8 cases, with 1 case developed new postoperative deficit, and the sensitivity and specificity of SEP were 100% and 77.3%, the sensitivity and specificity of MEP were 100% and 86.4%. Compared with preoperative SEP, 4 cases showed major improvement (baseline increase > 40%), 2 cases showed moderate improvement (baseline increase: 15%-40%). The coincidence rate of the SEP improvement and the AISA grade was 66.7%. Conclusion IONM could reduce the duration of operation and intraoperative blood loss. Changes of IONM were correlated with postoperative neurological function improvement. Key words: Cervical vertebrae; Neoplasms; Evoked potentials, somatosensory; Evoked potentials, motor; Electromyography

Efficacy of multimodal intraoperative neurophysiology monitoring to distinguish the nervous system injury during surgery for chronic cervical compressive myelopathy

Objective To study the efficacy of intraoperative neuromonitoring with SEP, MEP and EMG to predict of spinal cord and nerve root injury during surgery for chronic cervical compressive myelopathy. Methods From October 2014 to June 2016, 107 patients (80 males, 27 females) who underwent surgery for chronic cervical compressive myelopathy and intra-operative neuromonitoring with SEP, MEP and EMG were enrolled in this study. The mean age was 53.36±11.35 years (24-79 years), and the mean follow-up time was 7.94±6.05 months (1-18 months). The monitoring method, abnormal alarm, treatment and outcome of intraoperative SEP, MEP and EMG were recorded in all patients. The preoperative, postoperative and last follow-up neurologic functions were compared. True positive, false positive, true negative and false negative cases were collected in all patients. Sensitivity, specificity, positive predictive value and negative predictive value were calculated, and the utility of monitor spinal cord and nerve root injury was analyzed. Results SEP, MEP and EMG baseline values of 107 patients were established at the end of exposure. A total of 8 patients with intraoperative neurophysiology monitoring were abnormal (4 cases of anterior surgery, 4 cases of posterior surgery), including 1 case with abnormal SEP and MEP, but EMG was normal, he became incomplete paralysis postoperatively; 4 cases with abnormal MEP and EMG, but SEP was normal, they suffered C5 nerve root palsy postoperatively; 2 cases with abnormal MEP, while SEP and EMG were normal, one was C5 nerve root palsy and another was incomplete paralysis for the right side of the limb postoperatively; 1 case with abnormal EMG, but SEP and MEP were normal, he was C5 nerve root palsy postoperatively. 1 patient with anterior surgery was false negative of intraoperative neurophysiology monitoring, it was not found abnormal during surgery, but the patient was C5 nerve root palsy after operation. The utility of monitor spinal cord injury, the sensitivity and specificity of SEP was 50% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 99.06%. The sensitivity and specificity of MEP were 100%, positive predictive value and negative predictive value were 100%. The effect of monitor nerve root injury, the sensitivity and specificity of SEP was 0 and 100%, respectively. The positive predictive value was 0 and the negative predictive value was 93.46%. The sensitivity and specificity of MEP was 71.43% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 98.04%. The sensitivity and specificity of EMG sensitivity was 71.43% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 98.04%. Conclusion During operation of chronic cervical compressive myelopathy, SEP and MEP for spinal cord injury monitoring, and MEP and EMG for nerve root injury monitoring were effective ways to promise comprehensive monitor the spinal cord and nerve root system. Key words: Cervical vertebrae; Spinal cord compression; Evoked potentials, somatosensory; Evoked potentials, motor; Electromyography

Application of intraoperative neurophysiological monitoring in surgical correction for spinal deformity with different etiologies

Iatrogenic nerve injury is one of the most severe complications of surgical correction for spinal deformity with different etiologies. The intraoperative neurophysiological monitoring (IONM) has been widely used to detect the nerve injury in spinal correction surgery. The commonly used IONM techniques involve somatosensory evoked potential (SEP), motor evoked potentials (MEP) and electromyography (EMG). All the IONM techniques have both advantages and disadvantages, while combing SEP, MEP and EMG in the spinal correction surgery could maximumly improve the accuracy and reliability of the IONM. The different pathophysiology of patients with spinal deformity due to different etiologies might significantly decrease the success rate, sensitivity, and specificity of IONM, which might further decrease the reliability of IONM. However, the IONM still serves as the most important monitoring method for the iatrogenic nerve injury in patients with different spinal deformity due to different etiologies. For those monitoring changes that cannot be distinguished, the wake-up test is still the gold standard.

The high risk factors and prognosis of severe intraoperative neurophysiological monitoring events in patients with severe spinal deformity undergoing vertebral column resection

Objective To evaluate the severe intraoperative neurophysiological monitoring (IONM) event and its predictive value for the intraoperative neurologic impairment in patients with severe spinal deformity undergoing vertebral column resection (VCR), and to investigate the high risk factors and post-operative outcomes of severe IONM events. Methods Ten patients from January 2009 to June 2015 were retrospectively reviewed, of whom the average age was (19.9±17.1) years. The following parameters were evaluated for each patient: neurologic status at pre-operation, post-operation, and the last follow-up, the timing and type of severe IONM events, operative performance at severe IONM events, intraoperative treatment for severe IONM events and intraoperative change in severe IONM monitoring after treatment. Results Severe IONM events occurred at the stages of pedicle screw implanting in 1 (10%) patient, osteotomy in 5 (50%) patients and rod fixation in 4 (40%) patients, respectively. The stages of osteotomy and rod fixation were high risk phase for severe IONM events. Of the 10 patients, IONM monitoring significantly recovered after treatment in 3 patients, and they had no neurologic impairment at post-operation and at the last follow-up. The IONM monitoring significantly improved after treatment in 4 patients, of whom the post-operative neurologic impairment recovered at the last follow-up. The IONM monitoring did not improved after treatment in 3 patients, of whom the post-operative neurologic impairment only partly recovered at the last follow-up. Conclusion The multi-mode intraoperative IONM could help to early detect the neurologic impairment and improve the prognosis for patients undergoing VCR. Intraoperative osteotomy and rods contouring are high risk phase for severe IONM events. Patients with significantly improved IONM monitoring after intraoperative treatment could expect better recovery of neurologic function during follow-up. Key words: Spinal curvatures; Osteotomy; Evoked potentials, somatosensory; Evoked potentials, motor; Electromyography; Risk factors

The intraoperative neurophysiological monitoring abnormality in an achondroplasia patient with scoliosis and severe spinal stenosis: case report

The intraoperative neurophysiological monitoring abnormality in an achondroplasia patient with scoliosis and severe spinal stenosis: case report

Application and procedure of intraoperative neurophysiological monitoring in spine surgery

Application and procedure of intraoperative neurophysiological monitoring in spine surgery