Somatosensory evoked potentials during Harrington instrumentation for scoliosis.

Engler, Gordon L.; Spielholz, N J; Bernhard, W; Danziger, Fred; Merkin, Henry; Wolff, Thomas W.

doi:10.2106/00004623-197860040-00016

Cited by 205 publications

(33 citation statements)

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“…Somatosensory-evoked potentials (SEPs) were first used about 30 years ago to monitor the spinal cord during surgical correction for scoliosis. 1,2 Despite preservation of SEPs, however, serious motor deficits were observed, thus bringing into question their capacity to monitor spinal cord motor tracts.…”

Section: Introductionmentioning

confidence: 99%

Combined motor- and somatosensory-evoked potential monitoring for spine and spinal cord surgery: correlation of clinical and neurophysiological data in 85 consecutive procedures

et al. 2009

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Study design: Prospective study. Objectives: The primary objective of neurophysiological monitoring during surgery is to prevent permanent neurological sequelae. To avoid neurological injury, we applied somatosensory-evoked potentials (SEPs) and/or motor-evoked potentials (MEPs). We evaluated whether the combination of SEP and MEP for spinal surgery may be beneficial. Setting: Asian Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Methods: Combined SEP/MEP monitoring was attempted in 100 consecutive procedures for spinal operations. Trains of transcranial electrical stimulation over the motor cortex were used to elicit MEPs from the muscles of the upper/lower limbs. The tibial and median nerves were stimulated to record SEP. Results: Combined SEP/MEP recording was successfully achieved in 85 of 100 operations. In 61 of 85 operations (71%), SEP and MEP were stable, and all patients remained neurologically intact after surgery. Significant MEP changes were recorded in 20 operations, either combined with (n ¼ 4) or without (n ¼ 16) SEP changes. In 7 of these 20 operations, MEP recovered to some extent after surgical intervention, and these patients showed no neurological changes. In the remaining 13 operations, MEP did not recover and the patients had a transient (n ¼ 4) or a permanent (n ¼ 3) motor deficit. Significant SEP changes with stable MEP were observed in four operations, all of which were not related to postoperative motor deficit. Conclusion: Combined SEP/MEP monitoring provided higher sensitivity and higher positive/negative predictive value than single-modality monitoring techniques. Detection of MEP changes and adjustment of surgical strategy may prevent irreversible pyramidal tract damage.

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Section: Introductionmentioning

confidence: 99%

Combined motor- and somatosensory-evoked potential monitoring for spine and spinal cord surgery: correlation of clinical and neurophysiological data in 85 consecutive procedures

et al. 2009

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“…The intraoperative neurophysiologic monitoring (IOM), represented by motor evoked potential (MEP) and somatosensory evoked potential (SSEP), provides the functional integrity of spinal cord, and has become one of the essential procedures to avoid neural injury during spinal surgery [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…The importance of SSEP was appreciated earlier in the spinal deformity surgery, at which the correction of deformity and fixation might cause stretching or compression of the spinal cord [1,2,5]. Later, MEP has played role in intramedullary spinal cord tumour surgery, where motor and sensory pathway could be separately dissected [6,7].…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Kang¹,

Gwak²,

Shin³

et al. 2016

J Spine

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Objectives: To evaluate the feasibility, sensitivity and specificity of IOM for IDEM and ED metastatic spinal tumours, and to assess usefulness of SSEP for patients in whom MEP was not measurable. Methods and materials:One hundred and one consecutive patients with IDEM and ED metastatic spinal tumours at the cord level (C1 to L1) received surgery under SSEP and/or MEP was included. Feasibility of IOM was defined to be negative in case of no measurable MEP or SSEP under general anaesthesia after confirmation of reversal of neuromuscular block. More than 50% change of MEP or SSEP amplitude and more than 10% delay of SSEP latency were evaluated as positive signs of IOM change.Results: MEP was measurable in 74 out of 101 trials, thus feasibility is 73%. Patient with normal motor power showed higher feasibility than those with motor power 3 or less. (93% vs. 39%) Among 74 patients with measurable MEP, 19 patients showed positive MEP change and 14 patients got worse of their motor power postoperatively.

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“…The risk of irreversible neurological complications after these spinal surgery procedures ranges from 0.5 to 6.9% for corrections of vertebral deformities [8,22,26,36], to 20% for tumour resections and trauma surgery [12]. Other researchers report different statistical percentages of irreversible neurological complications for cervical myelopathies.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative control by somatosensory evoked potentials in the treatment of cervical myeloradiculopathy. Results in 210 cases

Sebastian¹,

Raya²,

Ortega³

et al. 1997

Eur Spine J

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Somatosensory evoked potentials (SEPs) were used for continuous monitoring of 210 patients during anterior surgery for cervical myeloradiculopathy, to test how effectively they help avoid irreversible neurological damage during surgery. The pathologies differed in severity and were treated by diskectomy or by extended corporectomy using the Senegas technique. Intraoperative SEP changes were recorded in 84 patients (40%); in 13 (6.2%) of these, changes in SEP amplitude and latency were caused by mechanical stress. SEPs revealed transient episodes of regional ischaemia or neurophysiological anomalies during anaesthesia (mainly hypotension) in 27 patients (12.8%). The traces detected incipient and potentially dangerous mechanical pressure on, or metabolic anomalies of, the spinal cord during manipulation and placement procedures of spinal fixation devices. They were particularly sensitive indicators of ischaemia; one of the most common causes of irreversible injury. The traces of 44 patients (21.0%) improved markedly during surgery. There were no falsenegatives in this series and, thanks to the fact that SEPs gave immediate warnings of incipient ischaemia to the surgical team, we had no case of irreversible medullary or nerve-root deficit.

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Somatosensory evoked potentials during Harrington instrumentation for scoliosis.

Cited by 205 publications

References 0 publications

Combined motor- and somatosensory-evoked potential monitoring for spine and spinal cord surgery: correlation of clinical and neurophysiological data in 85 consecutive procedures

Combined motor- and somatosensory-evoked potential monitoring for spine and spinal cord surgery: correlation of clinical and neurophysiological data in 85 consecutive procedures

Feasibility and Predictability of Intraoperative Monitoring in Patients with Intradural Extramedullary and Epidural Metastatic Spinal Tumors

Intraoperative control by somatosensory evoked potentials in the treatment of cervical myeloradiculopathy. Results in 210 cases

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