Spinal cord monitoring during posterior spinal instrumentation and fusion.
Two hundred seventy-five consecutive patients who were treated by posterior spinal instrumentation and fusion with iliac crest bone graft were intraoperatively monitored using cortical somatosensory-evoked potentials without a planned wake-up test. The monitoring was performed using a TECA TE-4 system that included an electromyograph, a nerve stimulator, and a digital averager. Intraoperatively, six patients (2%) demonstrated significant changes in evoked potentials, consisting of either marked increase in latency or a loss of wave form during instrumentation of the spine. The instrumentation was removed immediately and the evoked potentials returned to base-line tracing within 15-30 minutes in all six cases. Five patients who had instruments refitted to maintain a lesser amount of correction had no subsequent change in the evoked potentials. One patient had spinal fusion without instrumentation. Postoperatively, all patients are neurologically normal.
Bieber
E
E
Department of Orthopedic Surgery, Georgetown University Medical School, Bethesda, Maryland 20814.
Tolo
V
V
Uematsu
S
S
D000328:Adult; D016025:Bone Transplantation; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007738:Kyphosis / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D009984:Orthopedic Fixation Devices; D012600:Scoliosis / Q000503:physiopathology / Q000601:surgery; D013116:Spinal Cord / Q000503:physiopathology*; D013123:Spinal Fusion / Q000295:instrumentation*