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ApplicationsProceduresSpine surgeryLateral access to the spine

Nerve-sparing access to the lateral spine

The lateral access to the lumbar spine has the advantage that both the
intervertebral disc space and the vertebral bodies can be worked on and
the sensitive cauda fibers do not restrict the surgical field.

Introduction to the stimulation technique for lateral access to the lumbar spine

Surgical technique

Preparation

Electrode placement
The target muscles of the nerves of the lumbosacral plexus can be monitored using electromyography. Covering all four extremities with different muscle groups ensures that any changes that occur can be analysed quickly and technical defects can be ruled out rapidly.

A setup can contain, for example:

M. abductor pollicis brevis
M. vastus medialis
M. tibialis anterior
M. biceps femoris
M. gastrocnemius

Do not forget to place the ground electrodes.

The electrodes should be placed after the patients have been preoperatively informed and anaesthesia has been induced. Precise placement in the muscle and careful fixation, as well as the use of a bite block to prevent bite injuries, if necessary, must be observed.

Patient positioning
Depending on the access side, the patient is positioned in a padded lateral position. The operating table is bent so that the spine is slightly opened laterally. The height is now determined using X-rays and the skin incision is marked.

Important: Under no circumstances should muscle relaxants be administered during surgery, as these can prevent EMG recordings from being made. A TOF measurement should be carried out before monitoring begins to ensure that there is no residual effect.

Probe connection and technical test
The stimulation probe or stimulated dilator and reference electrode are inserted into the designated stimulation channel of the monitoring device. A functional test can now be carried out by immersing both instruments in a bowl of saline solution and activating the stimulation. The monitoring device should report that a current is flowing. The reference electrode is inserted into the tissue at the edge of the surgical field and firmly fixed. The probe or dilator can now be advanced into the psoas muscle under stimulation.

The following stimulation parameters should be used:

1 pulse, cathodal (negative)
1–3 Hz
10 mA

To ensure that everything is working technically, stimulation should initially be at up to 25 mA to document a positive muscle response. For stimulation, manual EMG programmes or automated stimulation up to a fixed threshold value (e.g. NeuroExplorer Spine or C2 Spine module) can be used.

Procedure

Product information

SDN electrodes 15/2000, stainless steel

533646

SDN electrodes 15/2000, stainless steel

1.5 mm touchproof connector DIN 42802, pair of electrodes red/black, red/white, blue/black, blue/white, yellow/black, yellow/white, violet/black, violet/white, grey/black, grey/white, needle length=15 mm, needle diameter=0.45 mm, cable length=2000 mm, disposable product, EO sterilized

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Spine surgery set for EMG recording

535640

Spine surgery set for EMG recording

Color-coded needle electrode set, 1.5 mm touchproof connector DIN 42802, pair of electrodes red/black, blue/black, blue/white, yellow/black, yellow/white, violet/black, violet/white, grey/black, grey/white, green ground needle, disposable product, EO sterilized

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Stimulation probe 200 mm monopolar, straight

525630

Stimulation probe 200 mm monopolar, straight

Straight for lateral approach in spine surgery, working length 200 mm, diameter 3 mm, active tip 1 mm with clip-on handpiece and neutral SDN electrode black, cable length 3000 mm, disposable product, EO sterilized

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Disposable Stimulation Clip with spring, monopolar

520048

Disposable Stimulation Clip with spring, monopolar

Intended for transmission of electrical signals in combination with recording/stimulation devices. For recording and stimulation of peripheral, cranial and spinal nerve roots. Cable length 2.5 m, 1.5 mm touchproof connector DIN 42802, suitable for connection to cannulas or dilators with 5 mm–22 mm diameter. Use separate needle electrode as reference electrode.

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Disposable pedicle screw probe, straight, ball tip

525617

Disposable pedicle screw probe, straight, ball tip

255 mm, monopolar, ball tip 2.3 mm, counter electrode not included

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Application package Spine for C2 Xplore

508544

Application package Spine for C2 Xplore

Consisting of software license "Spine", Body Box and license for 8-channel recording.

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C2 Xplore

508288

C2 Xplore

For intraoperative neuromonitoring. Easy-to-use 8-channel EMG monitor with 2 integrated stimulators, up to 6 application fields and digital integration in the operating room, maximum interconnection online and offline. Mains lead and foot switch included. Can be used in combination with an application package.

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inomed Xpert plus 32-channel system for neurosurgery

504004-32CH

inomed Xpert plus 32-channel system for neurosurgery

The powerful Xpert plus combines mobility with functionality. It consists of an equipment cart with panel PC, height-adjustable monitor, laser printer, keyboard drawer, two large accessory drawers, constant-current stimulator, amplifier with a total of 32 recording channels (56 inputs: 8 referential and 48 differential) and all necessary adapter boxes.

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inomed Xpert 32-channel system for neurosurgery

504005-32CH

inomed Xpert 32-channel system for neurosurgery

The powerful Xpert combines mobility with functionality. It consists of an equipment cart with panel PC, keyboard drawer, accessory basket, constant-current stimulator, amplifier with a total of 32 recording channels (56 inputs: 8 referential and 48 differential) and all necessary adapter boxes.

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inomed Xpert 16-channel system

504005-16CH

inomed Xpert 16-channel system

The powerful Xpert combines mobility with functionality. It consists of an equipment cart with panel PC, keyboard drawer, accessory basket, constant current stimulator, amplifier with a total of 16 recording channels (24 inputs: 8 referential and 16 differential) and all necessary adapter boxes.

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inomed Xpress 32-channel system for neurosurgery

504006-32CH

inomed Xpress 32-channel system for neurosurgery

The Xpress is the portable version of the IOM system. It consists of the Xpress base unit, trolley, notebook, notebook and accessory bag, constant current stimulator, amplifier with a total of 32 recording channels (56 inputs: 8 referential and 48 differential) and all necessary adapter boxes.

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inomed Xpress 16-channel system for spine surgery

504006-16CH

inomed Xpress 16-channel system for spine surgery

The Xpress is the portable version of the IOM system. It consists of the Xpress base unit, trolley, notebook, notebook and accessory bag, constant current stimulator, amplifier with a total of 16 recording channels (24 inputs: 8 referential and 16 differential) and all necessary adapter boxes. This system variant is optimally equipped for use in spine surgery.

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