Intraoperative spinal somatosensory evoked potential monitoring

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✓ The relationship of intraoperative monitoring of spinal cord somatosensory evoked potentials and postoperative deficit in 220 cases (121 with scoliosis, 41 with neoplasms, and 58 others) is reported. Bilateral posterior tibial nerve stimulation was used in 181 cases and unilateral median nerve stimulation in 39. Spinal cord (interspinous ligament needles), subcortical (neck surface), and cortical (scalp surface) SEP's were monitored. Seven patients had worsening of neurological function after surgery, three of whom demonstrated significant changes in SEP's monitored. In an additional four cases, there was more than a 50% decrease in amplitude of subcortical/cortical SEP's during monitoring, but no change in neurological status postoperatively. Combined monitoring of spinal cord, subcortical, and cortical SEP's enhanced the certainty of detecting spinal cord dysfunction even though there was a significant number of false-negative and false-positive results. A marked change in the SEP's indicated a high chance of developing a neurological deficit (three or 43% of seven cases), and if there was no change the chance of any neurological postoperative deficit was extremely low (four or 1.87% of 213 cases). These data justify the use of intraoperative SEP monitoring.

Article Information

Address reprint requests to: Dudley S. Dinner, M.D., Department of Neurology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44106.

© AANS, except where prohibited by US copyright law.

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Figures

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    Diagram of our technique of simultaneous recording of somatosensory evoked potentials: cortical (Cz-A1A2), subcortical (SC5-Fz), and spinal cord (IL3/4-Sk, IT2/3-Sk, interspinous ligaments above and below the level of surgery referred to a subcutaneous electrode). IL3/4 = the interspinous space between the L-3 and L-4 spinous process. IT2/3 = the space between the T-2 and T-3 spinous process. Sk = skin.

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    Simultaneous monitoring of spinal cord function from multiple levels. Stimulation: bilateral posterior tibial nerves. Recordings SC5-FZ = subcortical potentials; EZ-A1,A2 = cortical potentials; IL3/4-Sk, IT1/2-Sk = spinal cord potentials. SC5 = disc electrode at the spinal process of C-5; FZ = disc electrode at the midfrontal region; EZ = disc electrode at midline midway between the vertex (Cz) and the midparietal region (Pz); A1 and A2 = disc electrodes on left and right ear lobes; IL3/4 = interspinal ligament needle at L3 and L4; IT1/2 = interspinal ligament needle at T1 and T2; Sk = subcutaneous needle at a similar level. Filters: 150–1500 Hz for spinal cord potentials and 30–250 Hz for subcortical and cortical potentials.

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    Monitoring of spinal cord function from two levels. Stimulation: unilateral right median nerve stimulation. Recordings: CL2-FZ = afferent volley of peripheral nerve potentials; E3-A1A2 = cortical potentials. CL2 = disc electrode at the right midclavicular point; FZ = disc electrode at midfrontal position; E3 = disc electrode at the left parasagittal region midway between the left central (C3) and the left parietal P3 positions; A1A2= disc electrodes at the left and right ears linked. Filters: 150–1500 Hz for peripheral nerve potentials; 30–250 Hz for cortical potentials.

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    Results of monitoring in Case 2 with congenital scoliosis. Stimulation: bilateral posterior tibial nerves. Recordings: SC5-Fz = subcortical potentials, Ez-A1A2 = cortical potentials. Electrode positions SC5, Fz, Ez, A1, and A2 were as described in Fig. 2. Filters: 30–250 Hz for subcortical and cortical potentials.

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