My name is Blair Calancie. This is the homepage for NeuroGuidance, LLC.
NeuroGuidance
was founded in 2002, in response to numerous requests I had been receiving to
train people in how to monitor motor evoked potentials (MEPs) in the operating room
setting. Over two long days, we covered the theory and practice of MEP
monitoring, including about 6 interactive hours of edited video records from
actual surgery cases in which MEP monitoring was used. Participant
satisfaction with the course was uniformly high.
While I've
long-since stopped teaching this course, I continue to receive questions
related to intraoperative neuromonitoring (IONM; sometimes called
intraoperative monitoring (IOM), or simply neuromonitoring), and my other main
area of expertise: spinal cord injury (SCI).
I’ve
developed this simple website to help me respond to these questions in a timely
manner, and to allow others to share in any discussions that might emerge. On the Biography page, I’ve included
details about my background and training, my research interests and
accomplishments, and – giving credit where credit is due – the main sources of
my funding.
Several individual pages are devoted to specific research projects I've either carried out in the past, or which are still ongoing.
Most spinal cord injuries occur through trauma, like a car accident, a fall, or (like in my Miami days) a gunshot wound. Or .... they occur in the operating room. That is, in spite of our many medical
advances, the occasional patient undergoing surgery wakes up worse in terms of
neurologic function than he or she was before surgery. Maybe a blood vessel feeding the spinal
cord was inadvertently squeezed, or a pedicle screw was placed too close to the
spinal cord. Even brain function
might be compromised, such as when a blood clot from a carotid artery being
treated for narrowing (stenosis) breaks free and lodges in a smaller vessel feeding the
brain.
Intraoperative
neuromonitoring is designed to pick these types of events up, and warn the
surgical team when they occur.
With proper and timely warning, the surgeon might be able to do
something to reverse the changes that neuromonitoring picks up, preventing a
disastrous outcome. But –
and this is a big but – this type of monitoring is never simple. A lot of factors – ranging from
equipment failure, to anesthesia and metabolism, to pre-existing neurologic
dysfunction – can hinder the correct recognition and interpretation of signal
changes.
On my Consultation page, I explain how I’ve
sometimes helped legal professionals understand the role that IONM played – or did
not play – in
surgical cases that had bad outcomes.
That is, I can provide both an unbiased interpretation of most IOM records, as well as an
idea of that patient’s prospects for recovery from their surgery-associated
injury.
I can make
the above statements with the confidence borne of experience. I’ve been doing intraoperative
monitoring on a regular basis for the past 23 years. Several advances in the field that have evolved to become
‘standard of care’ in the United States – including stimulus-evoked EMG for
monitoring pedicle screw placement, and gaining FDA approval for transcranial
MEP monitoring – came out of my lab.
Beginning at The Miami Project to Cure Paralysis, I’ve been studying
patterns of recovery after spinal cord injury, in persons with both acute and
chronic injury, for just as many years.
I won’t say I’ve seen it all, because I continue to
learn in both the operating room and the laboratory setting. On the other hand, I’ve seen – and
learned – a great deal through these studies; I may be able to help some of you
better understand what you’re seeing or experiencing along these lines.