![]() ![]() Had IONM been utilized, the MEP/ SEP potentials would probably have been lost shortly after the DuraSeal was applied (i.e. This very complex multilevel anterior cervical corpectomy C4, C5 with C3-C6 fusion for OPLL was, unfortunately, performed without the benefit of intraoperative SEP, MEP or EMG monitoring. įAILURE TO USE INTRAOPERATIVE NEURAL MONITORING (IONM) SEP (SOMATOSENSORY EVOKED POTENTIALS), MEP (MOTOR EVOKED POTENTIALS), EMG (ELECTROMYOGRAPHY) single layer signs often with postiive C signs, and double layer signs) 2]. Had he done so, he would have seen the various signs of dural penetration present at multiple levels from C3-C6 (i.e. In this case, the surgeon failed to read the report or review the previously obtained CT images. CT’s usually provide a more direct image of punctate ossification/calcification within HPLL, or frank ossification/calcification within mature OPLL. Here, the preoperative MR clearly indicated the presence of multilevel OPLL spanning the C3-C4 through the C5-C6 levels. Although MR examinations may show hypertrophied posterior longitudinal ligament (PLL) typically at multiple disc spaces (i.e., a form of HPLL), mixed HPLL/OPLL masses can extend behind single/ multiple vertebral bodies. The best way to document the presence of OPLL is with a CT study, but MR’s can also show changes indicative of OPLL’s presence. ![]() FAILURE TO ASSESS PREOPERATIVE CT THAT SHOWED OPLL AND DURAL PENETRANCE ![]()
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