Temple Times Online Edition
    DECEMBER 2, 2004
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Nerve damage during spinal surgery preventable

Peripheral nerve injury, a significant problem during surgery, results in 15 percent of anesthesiology malpractice cases. According to a Temple study, certain standard surgical positions can increase the risk of nerve injury in the arms, but monitoring during surgery can help identify and reverse impending damage.

The researchers, led by Ihab Kamel, assistant professor of anesthesiology at the School of Medicine and Temple University Hospital, analyzed data on 996 patients who had undergone spinal surgery. The patients had been placed in one of five different surgical positions and all had been monitored for changes in nerve response using SSEP (somatosensory evoked potentials) monitoring.

A change in nerve response indicates a potential problem that could lead to permanent nerve damage. By monitoring and identifying nerve response changes, anesthesiologists can intervene and change the arm position.

The researchers identified the most changes occurring in two positions: lying on the side with arms extended and lying face down and arms extended above the head, known as the “Superman position.” In the patients studied, all of the changes were reversed, and none developed postoperative nerve injury.

“Reversible changes were frequently observed during spine surgery. Monitoring these changes has proved valuable in preventing position-related nerve injury,” Kamel said. “This is the first study to analyze nerve injury prevention in more than one surgical position and adds to our ability to understand and prevent potential postoperative nerve injuries.”

The study, “Positional upper extremity somatosensory evoked potential changes during spine surgery,” was presented at this year’s International Anesthesia Research Society meeting and was submitted for publication this fall.

- By Eryn Jelesiewicz