2000, Number 1
<< Back Next >>
Acta Ortop Mex 2000; 14 (1)
Standardization of method and record conditions of somatosensorial evoked potentials in corrective surgery for deformities of the spine. Neurophysiological study in 82 operated cases
Escobar-Cedillo RE, Castillo-Herrera M, Lona-Pimentel S, Rosales LM
Language: Spanish
References: 33
Page: 84-87
PDF size: 74.24 Kb.
ABSTRACT
There are reports of neurologic alterations after surgical interventions in the correction of spine deformities, due to the risk that they involve. It has been used an “wake up” test to evaluate the neurologic integrity, but this has not been enough. Therefore, there has been established neurophysiologic techniques such the somatosensorial evoked potentials (SEP) to value this integrity. This method, without being invasive, evaluates the somatosensorial track avoiding the risk of spinal cord injury; however, there has been observed too, in some occasions, “false positive” and “true positive” with it. In our hospital we studied 82 patients with an average of age of 15.4, to whom there were done SEP with recording from the neck and scalp and stimulation applied in tibial nerve to each leg. We didn’t find any significative difference in the records before and after the surgery with p › 0.05. In 9 patients the there were “false positive” and in 7 patients SEP were abnormal, showing postoperative neurological changes from dysesthesias to spinal cord injury. Due to the risk of neurological injury in such interventions one must monitoring not only with SEP the sensory track, but also the motor track with some other method to diminish the incidence of “false positive” and negatives, to give more reliable information to the surgeon for the benefit of the patient.
REFERENCES
Apel D, Gilbert M. Avoiding paraplegia during anterior spinal surgery. Spine 1991; 16(8) Supl.
Bradshaw PhD, Webb FR. Clinical evaluation of spinal cord monitoring in scoliosis surgery. Spine 1984; 9(6): 636-43.
Brown RH, Mash CL Jr. Current status of spinal cord monitoring. Spine 1979; 4: 466-70.
Brown HR. Intra-operative spinal cord monitoring. The adult spine. Principles and practice. New York, Raven Press LTD 1991.
Bruce BD. Spinal cord monitoring. Orthopaedic Clinics of North America 1988 19(2): 225-8.
Cracco RQ. Spinal evoked response peripheral nerve stimulation in man. Electroencephalograph Clin Neurophysiol 1993; 35: 379-86.
Chiappa HK. Evoked potential in clinical medicine Second Ed. 1990.
Dawson EG, Sherman JE, Kanim LE. Spinal cord monitoring results of scoliosis Research Society and European Spinal Deformity Society Survey Spine 1991; 16(8) 5: 5361-63.
Dinner PS, Luders A, Lesser RP. Intraoperative spinal somatosensory evoked potential monitoring. J Neurosurgery 1986; 65: 807-12.
Engler GL, Sielholz NJ, Bernard WN. Somatosensory cortical evoked potential during Harrington instrumentation for scoliosis. J Bone Joint Surg 1978; 60(A): 528-32.
Forbes HJ, Allen PW, Waller CS. Spinal cord monitoring in scoliosis surgery. J Bone Joint Surg 1991; 73(B): 487-91.
Kai Y, Owen J. Relationship between evoked potentials and clinical status in spinal cord isquemia. Spine 1994; 19: 1162-8.
Kalkman C. Variability of somatosensory cortical evoked potential during spinal surgery. Spine 1991; 16(8): 924-9.
Keim HA, Hadju MG. Somatosensory evoked potentials as an aid in the diagnosis and intraoperative management of spinal stenosis. Spine 1985; 10: 338-44.
Keith WR, Stanbough JL. Somatosensory cortical evoked potentials. A reviw of 100 cases of intraoperative spinal surgery monitoring. Journal of Spinal Disorders. 1990; (3): 220-6.
Lesser RP, Raudizens P, Luders H. Postoperative neurological deficit may occur despite unchanged intraoperative somatosensory evoked potentials. Ann Neurol 1986; 19: 22-5.
Mac Ewen W. The surgery of the brain and spinal cord. Br Med J 1988; 2: 302-9.
Mac Ewens GD, Bunell WP, Krishnaswami S. Acute neurological complications in the treatment of scoliosis. J Bone Join Surg 1975; 57(A): 404-8.
Mc Pherson RW, Mahla M. Effects of eufluranbe, isoflurane, and nitrous oxide on somatosensory evoked response in human. Anesthesiology 1985; 62: 626-33.
Machida M, Weinstein S, Yaneda T. Spinal cord monitoring: Electrophysiological spinal surgery. Spine 1985; 10: 407-13.
More CR, Nuwer RM. Cortical evoked potential monitoring during spinal surgery: sensitivity, specificity, realiability, and criteria for alarm. J Spinal Disord 1988; 1(1): 75-80.
Nuwer M. Monitoring spinal cord surgery with cortical somatosensory evoked potentials. Neuromonitoring in surgery. Ed. JE Desmedt 1989.
Nuwer M, Dawson EG, Carlson LG. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery: results of a large multicenter survey. Electroencephalo Clinical Neurophysiol 1995: 96: 6-11.
Owen J, Naito M. Relationship among level of distraction, evoked potentials, spinal cord ischemia and integrity, and clinical status in animals. Spine 1990; 15(9): 844-857.
Pathak KSA. Effects of halotane and fluorane, anisofluorane in nitrose oxide on multilevel somatosensory evoked potential. Anesthesiology 1989; 70: 207-12.
Perot DL Jr. The clinical use of somatosensory evoked potentials in spinal cord injury. Clin Neurosurgery 1973; 20: 367-81.
Spielhotz NL, Benjamín MV. Somatosensory evoked potential during decompression stabilization of the spine. Spine 1979; 4: 500-5.
Stuart J, Perlik MD. Somatosensory evoked potential surgical monitoring. Spine 1982; 17(3): 273-6.
Tetsuya T, Tetsuo N. Spinal cord monitoring as a clinical utilization of the spinal evoked potential. Clinical Orthopaedics and Related Research. 1984; 184: 58-63.
Tamaki T, Tsuji H. The prevention of iatrogenic spinal cord damage. Int Orthop 1996; 4: 313-317.
Vauzelle C, Stagmara JUR. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop 1973; 173-8.
Ueta T, Owen J, Sugioke Y. Effects of compression on physiologic integrity of the spinal cord, on circulation, and clinical status in four different directions of compression: posterior, anterior, circumferential, and lateral. Spine 1992:17(85) 5217-26.
Wilber RG, Thompson GH. Postoperative neurological deficits in segmental spinal instrumentation a study using spinal cord monitoring. J Bone Join Surg 1989: 66(A): 1178-7.