Date: Tue, 23 Nov 2004 13:00:23 -0600

From: Frederic B. Wilson, M.D.

Subject: Intraoperative Monitoring for Pelvis and Acetabular Surgery

To the group,

I have encountered several different approaches to intraoperative neurologic monitoring for pelvis and acetabular surgery. I would simply like to ask those who do these cases wether or not they are monitoring their patients. If so, what advantage does it give? What type of monitoring do you employ?

Thanks in advance,

Fred

Frederic B. Wilson, M.D.
ETMC First Physicians - Ortho Trauma Group
Tyler, Tx, 75701

Date: Tue, 23 Nov 2004 14:43:48 -0500

From: James Carr

I do not monitor. I have previously used SSEP and evoked emg, and eventually abandoned both due to technical difficulties intraop, which led to lack of reliability. May have been problems with my center. My rate of iatrogenic nerve injury is in line with literature.

Jim Carr

James B. Carr, MD
Premier Orthopedic Specialists
Columbia, SC 29203

Date: Tue, 23 Nov 2004 14:05:18 -0600

From: Frederic B. Wilson, M.D.

Jim,

I also do not monitor, for similar reasons. We found that the positioning and moving intraoperatively routinely caused problems with leads, etc. Thanks.

Fred

Date: Tue, 23 Nov 2004 12:20:45 -0800

From: Chip Routt

Sometimes....but you knew that already...we haven 't changed our monitoring indications since you worked here during your residency many moons ago.

Here are the most common scenarios-

• When there is significant displaced osseous debris within a sacral nerve root tunnel, or when we use lumbopelvic fixation, or when there is an associated other level spinal injury that is being fixed at the same anesthesia...in these situations we work together with our Spine team colleagues and they use monitoring...so it s available to us too.
• We also will monitor a patient without a preoperative neuro exam due to other associated injuries who has a significant posterior pelvic ring disruption (usually a transforamenal sacral fracture) with wide displacement. Such info gives us baseline info just prior to surgery and intraop info especially during the reduction, and also fixation.

I m no neurodiagnostic/monitoring expert, so if you want details about the monitoring, I d refer you to Dr. Jeff Slimp...he s still here too!

Thanks Fred-

Chip

M.L. Chip Routt, Jr.,M.D.

Professor-Orthopedic Surgery

Harborview Medical Center

Seattle, WA 98104-2499