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Spinal Cord Injury, Recovery and Rehabilitation

Blair Calancie, Ph.D.
Professor

Natalia Alexeeva, Ph.D.
Assistant Professor

Intraoperative Monitoring of CNS Function During Surgery.

We have a long history of developing electrophysiologic tests for helping to prevent neurologic injury to the brain, spinal cord, and nerve roots during surgical procedures that place these structures at risk.  We were the first group to publish a technique for monitoring pedicle screw placement in the lumbosacral spine, with a method that is now considered a standard of care in most major spine centers.  We also were instrumental in gaining FDA approval of a device for noninvasive stimulation of the brain’s motor cortex during surgery, in order to monitor the motor evoked potential (MEP).  This approach, approved by the FDA in August of 2002 and now in widespread use across the US, has been shown to help prevent spinal cord injuries during such procedures as correction of scoliotic deformity, and resection of spinal cord tumors.

We have recently initiated a new study to develop a reliable method for preventing medially directed errors in placement of screws into thoracic-level pedicles.  The technique combines key elements of our lumbar pedicle screw and MEP protocols.  A thoracic pedicle screw placed medial to the pedicle will enter the canal space, and could potentially compress and/or lacerate the spinal cord.  Needless to say, the neurologic consequences of such a placement can be devastating.  Preliminary findings from our first 5 subjects indicate the technique is working exceptionally well, and we are confident we have already prevented the misdirection of several screws.

A new area of research we are considering is to apply novel monitoring techniques for detection of cerebral ischemia during cardiac surgery.  The incidence of cognitive decline following cardiac surgery can exceed 25% in some studies, yet few centers are actively working to detect these events – caused by air or fat emboli, for example – and intervene with neuroprotective measures.  Our goal is to develop an animal stroke model and evaluate the ability of these monitoring techniques to recognize such events.

Finally, we have begun an investigation into the neurologic basis for the development of scoliosis.  This work is preliminary in nature, and is a direct result of our work in the operating room environment, summarized above.  We hypothesize that the pattern of nerve connections from motor cortex to the spinal cord is different in persons with scoliosis than that seen in persons without scoliosis.  To address this possibility, we are: 1) using single-pulse TMS and fMRI to map motor cortex; 2) testing manual dexterity; and 3) quantifying expression of key pathfinding genes.  All of these procedures assess in a direct or indirect way the anatomy and physiology of the corticospinal tract; we suspect that abnormalities of this pathway’s innervation of the thoracic spinal cord contribute directly to the development of scoliosis.