Spine Surgery
Neuromonitoring in spine surgery
The spinal cord includes the descending motor nerves that mainly carry impulses from the brain to the muscles, as well as the ascending sensory pathways that transmit information from the peripheral sensory organs to the brain.

The Situation
Distinguishing between neuromonitoring of efferent (descending) motor pathways via EMG (electromyography) and motor evoked potentials (MEP), and neuromonitoring of afferent (ascending) pathways using somatosensory evoked potentials (SEP) is vital. However, with our AVALANCHE® PLUS, what appears complex can be simplified, especially in surgical scenarios requiring simultaneous measurements with different methods.
Application
Spinal surgical procedures, such as those addressing scoliosis, kyphosis, decompressions, degenerative spinal conditions, discectomy, spinal tumour resection, and pedicle screw insertion, among others.

AVALANCHE® PLUS EMG
For precise monitoring of motor pathways
The spinal cord comprises descending motor nerves responsible for transmitting brain impulses to muscles, alongside ascending sensory pathways transmitting sensory information to the brain.
Distinguishing between monitoring of descending motor pathways using electromyography (EMG) and motor evoked potentials (MEP), and monitoring of ascending pathways using somatosensory evoked potentials (SEP) is crucial.
Despite its apparent complexity, our AVALANCHE® PLUS simplifies the process. In surgical scenarios requiring simultaneous measurements and a mix of methods, AVALANCHE® PLUS offers a novel approach.
Applications AVALANCHE® PLUS finds utility in various spinal surgeries including scoliosis correction, kyphosis treatment, decompression procedures, managing degenerative spinal conditions, discectomy, spinal tumour resection, and pedicle screw insertion.

Pedicle Screw evaluation
with AVALANCHE® PLUS and Monopolar Ball Probe
Specific monopolar stimulation probes are tailored for pedicle screw insertion, allowing stimulation within the bore hole or through surgical instruments during drilling and screwing. Increased signal activity on the neuromonitor post-stimulation signals potential nerve compression or pedicle wall perforation, warranting caution.
Activating the pedicle screw stimulator in AVALANCHE® PLUS software is a simple push-button process. The user interface mirrors the AVALANCHE® PLUS I/O-Box design, with colour and shape-coded probe connectors for clarity.
In the main window, users can display all measuring windows or focus on a single modality. Opt for the EMG view to monitor pedicle screws, ensuring essential signal changes are visible on the large touch screen.
AVALANCHE® PLUS MEP
Assessing central motor pathways
Motor evoked potentials (MEPs) are a specific type of evoked potentials, detected via EMG. Triggered by transcranial or direct cortical stimulation, these signals are captured in the corresponding extremity muscles. This facilitates swift evaluation of the spinal cord’s condition and functionality by surgeons. If you’ve set up an AVALANCHE® PLUS EMG system, configuring MEPs is straightforward. Muscle group selection is pre-done, allowing users to create MEP measuring windows effortlessly via drag-and-drop.
When the transcranial stimulator releases stimulation pulses, AVALANCHE® PLUS automatically initiates MEP measurement. MEP signals are displayed in the measuring window without user intervention. Opt for the MEP view to comfortably monitor critical surgical phases.


AVALANCHE® PLUS SEP
Monitoring spinal cord ascending pathways
To safeguard against post-operative neurological deficits, somatosensory evoked potentials (SEPs) are continuously assessed with AVALANCHE® PLUS SEP. Real-time signals are compared to the baseline signal recorded shortly after anaesthesia induction.
SEPs are generated by electrically stimulating the median nerve at the wrist or the tibial nerve at the foot, acquired cortically or subcortically. Changes in amplitude and latency indicate potential nerve threats during surgery.
AVALANCHE® PLUS SEP software features pre-set SEP channels. With a simple button press, median nerve SEP stimulation is activated. Manual signal channel creation is obsolete; the system automatically generates channels, identifies 10-20 system positions, and selects stimulation channels.
Assign electrode connectors to highlighted 10-20 system positions effortlessly via drag-and-drop on the touch screen. Simultaneously, AVALANCHE® PLUS generates a SEP measuring window for comprehensive monitoring of all SEP signals during surgery.

Stimulation Probe
Electric stimulation of nerves and neuronal structures
Choose from Bipolar or Monopolar, Fork-tipped, Ball-tipped, we offer a variety of probes tailored to your needs. We’re here to guide you through the benefits and usage of each type.
Our comprehensive range caters to almost every scenario, with stimulation probes crafted with ergonomic precision.
Crafted in Germany with meticulous attention to detail by Dr. Langer Medical, ensuring quality you can trust.

Needle Electrodes
Colour-coded needle electrodes for recording and stimulation
Whether you require single or multiple channels for recording EMG or EP signals, or need to stimulate nerves and muscular tissue, Dr. Langer Medical GmbH offers a wide range of needle electrodes for neuromonitoring.
Choose from various lengths, shapes, geometric arrangements, and a selection of colours tailored to your specific application needs – the options are abundant.