Endoscopic Posterior Approach for Cervicothoracic and Upper Thoracic Foraminotomies: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Robert B Kim ◽  
Bornali Kundu ◽  
Mark A Mahan
Keyword(s):  
Open Systems ◽  
Motor Evoked Potentials ◽  
Foraminal Stenosis ◽  
Abductor Pollicis Brevis ◽  
Tubular Retractor ◽  
Left Hand ◽  
Lower Trunk ◽  
Upper Thoracic ◽  
Posterior Foraminotomy ◽  
Intrinsic Muscles

Abstract Lower cervical and cervicothoracic radiculopathies can be challenging to treat through an anterior approach in patients with short-statured necks. With unilateral pathology, a posterior foraminotomy affords preservation of motion and avoids risks to anterior structures; yet, traditional open or even tubular retractor-based open systems are associated with postoperative muscle pain. Endoscopic approaches reduce muscle retraction and resection and are associated with shorter recovery time. This video demonstrates the endoscopic technique for performing cervicothoracic and thoracic foraminotomies. We present the case of a patient with severe left-hand weakness, particularly in grasp and hand intrinsic muscles. The differential diagnosis included a combined median and ulnar neuropathy, lower trunk plexopathy, medial cord plexopathy, thoracic outlet syndrome, and combined C8 and T1 radiculopathies. Imaging did not show brachial plexus pathology; instead, severe foraminal narrowing at the C8 and T1 roots was noted. We performed a fully endoscopic approach to decompress 2 levels of foraminal stenosis on the left side. Because the levels were adjacent, we operated through a single incision. Recovery of motor-evoked potentials to the abductor pollicis brevis was identified intraoperatively.  The patient consented to the procedure and publication.

Suppression of Corticospinal Excitability During Negative Motor Imagery

2003 ◽  
Vol 90 (4) ◽  
pp. 2303-2309 ◽  
Author(s):  
Young H. Sohn ◽  
Nguyet Dang ◽  
Mark Hallett
Keyword(s):  
Motor Imagery ◽  
Motor Evoked Potentials ◽  
Intracortical Inhibition ◽  
Corticospinal Excitability ◽  
Intracortical Facilitation ◽  
Abductor Pollicis Brevis ◽  
Paired Pulse ◽  
Left Hand ◽  
Resting Motor Threshold ◽  
Conditioning Stimuli

To investigate the effect of negative motor imagery on corticospinal excitability, we performed transcranial magnetic stimulation (TMS) studies in seven healthy subjects during imagination of suppressing movements. Subjects were asked to imagine suppression of TMS-induced twitching movement of their nondominant left hands by attempting to increase the amount of relaxation after receiving an auditory NoGo cue (negative motor imagery), but to imagine squeezing hands after a Go cue (positive motor imagery). Single- and paired-pulse TMS were triggered at 2 s after Go or NoGo cues. Motor-evoked potentials (MEPs) were recorded in the first dorsal interosseus (FDI), abductor pollicis brevis (APB), and abductor digiti minimi (ADM) muscles of the left hand. Paired-pulse TMS with subthreshold conditioning stimuli at interstimulus intervals of 2 (short intracortical inhibition) and 15 ms (intracortical facilitation) and that with suprathreshold conditioning stimuli at interstimulus interval of 80 ms (long intracortical inhibition) were performed in both negative motor imagery and control conditions. Compared with the control state (no imagination), MEP amplitudes of FDI (but not APB and ADM) were significantly suppressed in negative motor imagery, but those from all three muscles were unchanged during positive motor imagery. F-wave responses (amplitudes and persistence) were unchanged during both negative and positive motor imagery. During negative motor imagery, resting motor threshold was significantly increased, but short and long intracortical inhibition and intracortical facilitation were unchanged. The present results demonstrate that excitatory corticospinal drive is suppressed during imagination of suppressing movements.

Role of tacrolimus in return of hand function after brachial plexus injury in a lung transplantation patient

2020 ◽  
Vol 13 (5) ◽  
pp. e233788
Author(s):  
Tiam M Saffari ◽  
Christopher J Arendt ◽  
Robert J Spinner ◽  
Alexander Y Shin
Keyword(s):  
Lung Transplantation ◽  
Brachial Plexus ◽  
Brachial Plexus Injury ◽  
Hand Function ◽  
Left Hand ◽  
Lower Trunk ◽  
Bilateral Lung Transplantation ◽  
Bilateral Lung ◽  
Transplantation Patient

We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a brachial plexus injury (BPI), with unusual improvement of lower trunk innervated hand function. The lower trunk injury with resultant left hand paralysis had developed after his sternotomy 18 months ago. He has been treated with tacrolimus as part of his immunosuppression protocol since the surgery, without severe side effects. Physical examination at 18 months demonstrated unusual excellent grip pattern and full opposition of his thumb with slight claw deformity of his ulnar two digits. While the neurotoxic effects of tacrolimus are more emphasised, the neuroregenerative properties have been recently explored. The recovery in this patient is unique and unusual after BPI and is most likely as a result of the low dose tacrolimus treatment.

Changes in interhemispheric inhibition from active to resting primary motor cortex during a fine-motor manipulation task

2012 ◽  
Vol 107 (11) ◽  
pp. 3086-3094 ◽  
Author(s):  
Takuya Morishita ◽  
Kazumasa Uehara ◽  
Kozo Funase
Keyword(s):  
Motor Cortex ◽  
Primary Motor Cortex ◽  
Motor Evoked Potentials ◽  
Conditioning Stimulus ◽  
Fine Motor ◽  
Interhemispheric Inhibition ◽  
Left Hand ◽  
Resting Motor Threshold ◽  
Inhibitory Circuit ◽  
Task Conditions

The effect of performance of a sensorimotor task on the interhemispheric inhibition (IHI) induced from the active primary motor cortex (M1) to the resting M1 was examined in 10 right-handed subjects. Transcranial magnetic stimulation (TMS) was performed to produce motor evoked potentials (MEP) in the resting right (Rt)-first dorsal interosseous (FDI). For the paired-TMS paradigm, a conditioning stimulus (CS) was delivered to the Rt-M1, and its intensity was adjusted from 0.6 to 1.4 times the resting motor threshold of the MEP in the left (Lt)-FDI in 0.2 steps. The test stimulus was delivered to the Lt-M1, and its intensity was adjusted to evoke similar MEP amplitudes in the Rt-FDI among the task conditions. The interstimulus interval was fixed at 10 ms. As a sensorimotor task, a fine-motor manipulation (FM) task (using chopsticks to pick up, transport, and release glass balls) was adopted. In addition, an isometric abduction (IA) task was also performed as a control task. These tasks were carried out with the left hand. The IHI from the active to the resting M1 observed during the FM task was markedly increased compared with that induced during the IA task, and this effect was not dependent on the MEP amplitude evoked in the active Lt-FDI by the CS. The present findings suggest that the increased IHI from the active to the resting M1 observed during the FM task was linked to reductions in the activity of the ipsilateral intracortical inhibitory circuit, as we reported previously.

scholarly journals Transcranial Magnetic Stimulation Following A Paired Associative Stimulation Protocol Based On A Videogame Potentiates Cortical Plasticity And Motor Behavior

2021 ◽  
Author(s):  
Arantzazu San Agustín ◽  
Guillermo Asín-Prieto ◽  
Juan C Moreno ◽  
Antonio Oliviero ◽  
José L Pons
Keyword(s):  
Magnetic Stimulation ◽  
Sham Group ◽  
Motor Behavior ◽  
Motor Evoked Potentials ◽  
Single Pulse ◽  
Main Task ◽  
Abductor Pollicis Brevis ◽  
Paired Associative Stimulation ◽  
Dynamic Task ◽  
Time Accuracy

Abstract BackgroundTranscranial Magnetic Stimulation (TMS) can induce synaptic plasticity potentiation following a paired associative stimulation (PAS) protocol, synchronizing a TMS single pulse with a movement task, named movement-related cortical stimulation (MRCS). However, MRCS plasticity induction and performance potentiation has been related exclusively to single movement tasks.MethodIn order to unveil the changes in motor learning produced by the MRCS protocol in complex movements, associated to Activities of Daily Living (ADL), we induced PAS changes in synchronization with a movement-related dynamic task by performing a customized videogame. We measured the task performance as well as nervous system excitability neuromodulation in 22 healthy subjects, analyzing Reaction Time (RT) and the peak-to-peak amplitude of the Motor Evoked Potentials (MEPs) respectively. The MEPs were recorded in the main task executor muscle, Abductor Pollicis Brevis (APB), and a secondary muscle, Abductor Digiti Minimi (ADM), before, right after, and 30 minutes after the intervention, in a real against sham group experimental parallel design. ResultsPAS application in synchronization with a complex task resulted in a motor performance potentiation effect, inducing shorter RTs when compared to the sham group. Moreover, it triggered long-term corticospinal plasticity mechanisms reflected in a MEP amplitude depression for the APB muscle at the higher intensity of recruitment curve and an enhancement of the corticospinal excitability of ADM muscle at around threshold intensity. RTs and ADM MEP amplitudes correlated positively in around threshold and high intensity assessments.ConclusionsWe conclude that the proposed PAS protocol facilitated the learning of time-accuracy movement in complex movement tasks, even if fatigue could be affecting the executor muscle excitability, and enhanced potentiation towards a passive muscle. This phenomenon can be very useful to develop neurorehabilitation strategies with complex movements (more similar to ADLs) and to avoid maladaptive plasticity related likely to fatigue.

scholarly journals Peculiarities of motor evoked potential in healthy children of different age

2019 ◽  
Vol 19 (4) ◽  
pp. 228-231
Author(s):  
Vladislav B. Voitenkov ◽  
N. V. Skripchenko ◽  
A. V. Klimkin ◽  
A. I. Aksenova
Keyword(s):  
Normative Data ◽  
Evoked Potential ◽  
Motor Evoked Potentials ◽  
Pediatric Population ◽  
Motor Evoked Potential ◽  
Conduction Time ◽  
Healthy Children ◽  
Abductor Hallucis ◽  
Abductor Pollicis Brevis ◽  
Pediatric Disorders

Aim of the work The implementation of the database for reference values of motor evoked potentials (MEP) in healthy children of different ages. Methods 95 healthy children were enrolled. Age ranged from 1 to 204 months. Three subgroups were established: children of 1-12 months (n=31, 18 males, 13 females), 12-144 months (n=27, 14 males, 13 females) and 144-204 (n=37, 20 males, 17 females) months. All children were healthy. Diagnostic transcranial magnetic stimulation (TMS) was performed in all patients. MEP shape, threshold, latency and amplitudes were recorded for hands (m. Abductor pollicis brevis) and legs (m. Abductor Hallucis). Central motor conduction time (CMCT) was calculated. Results. Along with age there was observed the elongation of MEP latency, gain in amplitudes and shape normalization. There were significant differences in the elongation of MEP latency between children aged of 1-12 months and children from two other subgroups (12-144 and 144-204 months). Conclusions. Our normative data can be usedfor comparative studies in the broad spectrum of pediatric disorders. Age restrictions have to be taken in a consideration when performing the TMS in pediatric population.

scholarly journals Restoration of hand function with long-term paired associative stimulation after chronic incomplete tetraplegia: a case study

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
A. Rodionov ◽  
S. Savolainen ◽  
E. Kirveskari ◽  
J. P. Mäkelä ◽  
A. Shulga
Keyword(s):  
Spinal Cord ◽  
Muscle Strength ◽  
Motor Evoked Potentials ◽  
Hand Function ◽  
Left Hand ◽  
Hand Muscles ◽  
Cord Injury

Abstract Introduction This case study explores the gains in hand function in an individual with a chronic spinal cord injury (SCI). The intervention was long-term paired associative simulation (PAS). We aimed to provide PAS until full recovery of hand muscle strength occurred, or until improvements ceased. Case presentation A 46-year-old man with traumatic C7 AIS B tetraplegia was administered PAS three times per week. After 24 weeks, PAS was combined with concomitant motor training of the remaining weak hand muscles. Outcome measures included the manual muscle test (MMT), motor-evoked potentials (MEPs), F-responses, hand functional tests, and the spinal cord independence measure (SCIM). Discussion After 47 weeks of PAS the subject had improved self-care and indoor mobility and was able to perform complex motor tasks (SCIM score improved from 40 to 56). His left hand regained maximum MMT score (total 75; increase of score from baseline condition 19); the effect remained stable in the 32-week follow up. In the right-hand muscles, MMT scores of 4–5 were observed in follow up (total 71; increase from baseline 48). Improved values were also observed in other outcomes. This is the first demonstration of long-term PAS restoring muscle strength corresponding to MMT scores of 4–5 in an individual with chronic SCI. The effect persisted for several months, indicating that PAS induces stable plastic changes in the corticospinal pathway.

scholarly journals Two-Level Minimally Invasive Lumbar Laminectomy and Foraminotomy: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Ethan S Srinivasan ◽  
Clifford L Crutcher ◽  
Timothy Y Wang ◽  
Peter M Grossi ◽  
Khoi D Than
Keyword(s):  
Minimally Invasive ◽  
High Speed ◽  
Hospital Length ◽  
Spinal Nerve ◽  
Hospital Length Of Stay ◽  
Foraminal Stenosis ◽  
Tubular Retractor ◽  
Open Operation ◽  
Spinous Processes ◽  
Patient Reported

Abstract Minimally invasive lumbar laminectomies utilize tubular retractors to minimize tissue disturbance, blood loss, and hospital length of stay compared to open operations. Here, we highlight the operative treatment of a 68-yr-old male entailing a 2-level minimally invasive lumbar laminectomy and foraminotomy at L2-L3 and L3-L4. The patient initially presented with symptoms of treatment-refractory lower extremity numbness and limited ambulation. His imaging demonstrated coronal scoliosis and severe lumbar central and foraminal stenosis at L2-L3 and L3-L4, with enlarged spinous processes, laminae, and facets. The patient consented to the procedure and publication of their image. The operation proceeded with the patient in a prone position with paramedian dissection to the lamina through a minimally invasive tubular retractor. Laminectomies and foraminotomies were performed at each level with high-speed drill and a Kerrison rongeur, with care to identify and protect the relevant spinal nerve roots. Postoperatively, the patient reported significantly reduced numbness and improved ambulation, with a well-healed surgical incision notably smaller than those produced in an open operation.

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