Sushil Basra's research while affiliated with Huntington Hospital and other places
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Publications (12)
Background: The transpsoas lateral lumbar interbody fusion (LLIF) technique is an effective alternative to traditional anterior and posterior approaches to the lumbar spine. The advantages of the far lateral lumbar approach are well documented, however iatrogenic injuries to the lumbar plexus are the most commonly reported post-operative complicati...
C5 neuropraxia is a known, poorly understood complication of cervical spine surgery and has a reported incidence as high as 30% in some studies. Weakness of the deltoid and biceps muscles present immediately postoperatively or in a delayed fashion. The exact etiology remain elusive and controversy regarding the efficacy and utility of neuromonitori...
A case report is presented that describes the authors lumbar plexus based anatomical approach to choosing EMG target muscles for neural mapping during LLIF procedures. The obturator nerve was identified during this procedure, which may not have been assessed using a myotomal nerve root based approach which is commonly advocated.
C5 neuropraxia is a known, poorly understood complication of cervical spine surgery and has a reported incidence as high as 30% in some studies. Weakness of the deltoid and biceps muscles present immediately postoperatively or in a delayed fashion. The exact etiology remain elusive and controversy regarding the efficacy and utility of neuromonitori...
Text:
Summary: Femoral nerve injury from excessive or prolonged retraction of the psoas muscle during LLIF surgery can be a devastating complication. Multiple investigators have reported that observing free running electromyography (EMG) recordings alone may be unreliable in providing an alert for impending femoral nerve injury. A multi-modal neur...
Background Context: New neuromonitoring techniques (saphenous somatosensory evoked potentials [sSSEP] & transcranial motor evoked potential recordings from the quadriceps muscles (qMEP) are currently under investigation as multiple authors have described similar promising initial findings in transpsoas lateral lumbar interbody fusion (LLIF) procedu...
Background Context: Transpsoas lateral access spine surgery has many advantages as an alternative to traditional anterior or posterior approaches for discectomy and fusion. Despite neural mapping using triggered EMG to avoid injury to the lumbar plexus elements, femoral nerve deficits suspected from excessive or prolonged tissue dilation or retract...
Detecting potential intraoperative injuries to the femoral nerve should be the main goal of neuromonitoring of lateral lumber interbody fusion (LLIF) procedures. We propose a theory and technique to utilize motor evoked potentials (MEPs) to protect the femoral nerve (a peripheral nerve), which is at risk in LLIF procedures. MEPs have been advocated...
There has been a major trend in surgery towards less invasive procedures performed through smaller surgical apertures. Smaller surgical openings are associated with decreased visualization, and surgeons must rely more on intraoperative tools including fluoroscopic imaging and motor nerve mapping techniques to assess their relative anatomical positi...
Background context:
Lateral spacers (LSs) are the standard of care for a lateral lumbar interbody fusion. However, various types of fixation, such as bilateral pedicle screws (BPSs), unilateral pedicle screws (UPSs), bilateral facet screws (BFSs), and lateral plates (LPs) have been reported to increase the stability of LSs. The biomechanics of a n...
Study design:
A retrospective analysis of a case series was performed.
Objective:
To describe a novel technique to monitor femoral nerve function by analyzing the saphenous nerve somatosensory evoked potential (SSEP) during transpsoas surgical exposures of the lumbar spine.
Summary of background data:
During transpsoas direct lateral approache...
Citations
... We have read with great interest and enthusiasm the published article by Chaudhary et al. entitled ''Trans-cranial motor evoked potential detection of femoral nerve injury in transpsoas lateral lumbar interbody fusion'', as this has been our research focus for the past 5 years and we have subsequently published two articles and multiple abstracts since 2012 on neuromonitoring for femoral nerve protection in lateral lumbar interbody fusion procedures (LLIF) [1][2][3][4][5][6][7]. Chaudhary's publication is of great importance as femoral nerve injuries are the most feared neurological complication during LLIFs and the result can be devastating for the patient. ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/279451813335045-1443637912904_Q64/Justin-Silverstein.jpg)
... [9][10][11][12][13][14] Intraoperative neuromonitoring (IONM) is a multimodal electrophysiological technique that measures somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMG) activity to evaluate neurophysiological integrity during surgery. [15][16][17][18] IONM has become popular because of its ability to aid surgeons in identifying intraoperative nerve injury in a timely manner and provide them with the opportunity to reverse or correct a potentially precipitating event. [15][16][17]19 Numerous prior studies have suggested that neuromonitoring can substantially reduce the risk of neural injury, particularly in cases with complex bony correction or nerve root/cord manipulation, such as in adult spinal deformity or tumor surgery. ...
... Meanwhile, studies have also repeatedly proven that the fixation stability of BPS is better than that of ALSR screw fixation [42][43][44]. Moreover, our numerical simulations also computed the stress distribution of ALSR and BPS in OLIF models. ...
![[object Object]](https://i1.rgstatic.net/ii/profile.image/279098610995201-1443553702080_Q64/Manasa-Gudipally.jpg)
... A multimodality approach with the addition of TcMEP can improve patient outcome by detecting functional nerve changes that do not elicit EMG activity [95]. Saphenous nerve SSEPs have also shown to be sensitive to femoral nerve insult during the lateral transpsoas approach to lumbar spine [96][97][98]. Thus, it is advised to incorporate evoked potentials with EMG to optimize IONM results in lateral transpsoas surgery. ...
Reference: Intraoperative Electromyography
... IOM has shown useful in a variety of spinal procedures. 3,[10][11][12][13][14] Procedure specific-IOM modality use is guided mainly by availability and physician or institutional preferences. 5,9 There is general consensus that multi-modal IOM is superior to any single IOM modality. ...
