Intraoperative Neurophysiologic Spinal Cord Monitoring in Thoracolumbar Burst Fractures
Bibliographic record
Abstract
STUDY DESIGN: Clinical prospective cohort study in academic tertiary setting. OBJECTIVE: Evaluate intraoperative neurophysiologic monitoring of the spinal cord in patients with thoracolumbar burst fractures. SUMMARY OF BACKGROUND DATA: The majority of clinical studies using intraoperative neurophysiologic monitoring in spinal trauma focus exclusively on somatosensory-evoked potentials (SSEP), and there are no specific article on the use of transcranial motor-evoked potentials (TcMEP), and stimulated electromyography (SEMG) by direct stimulation of the pedicular screws in thoracolumbar burst type fractures. In addition, controversy regarding the relation between spinal cord decompression and improvement in spinal cord function in such patients remains. METHODS: Eighteen patients with thoracolumbar burst type fractures (<3 weeks) who underwent indirect posterior spinal cord decompression was carried out from 2002 to 2006. Patients were monitored intraoperatively by SSEP, TcMEP, and SEMG. Findings that suggested worsening of spinal cord function were as follows: reduction in SSEP amplitude greater than 50% or increased latency time of 10%; and increased TcMEP of 100 V. Signs of improvement were 20% increase in SSEP amplitude and 20% decrease in TcMEP stimuli intensity. Four (22%) patients presented neurologic deficit. The mean American Spinal Injury Association (1993) score for motor function was 99+/-29 (range, 90-100). The mean American Spinal Injury Association (1993) score for sensory function was 111+/-32 (range, 107-112). RESULTS: There were no significant changes in the spinal cord function during the surgical procedure, although a decrease in the mean latency could be observed after spinal cord decompression (43.21x40.86; P<0.01). Two screws triggered SEMG responses and were replaced. All cases were true negatives. CONCLUSION: No significant changes in spinal cord function (to better or worse) were found in the current series after indirect spinal cord decompression through a posterior approach in patients with mild or no neurologic deficits. Further studies with larger series of patients presenting severe neurologic deficits are necessary to better establish these findings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".