title: Efficacy of spinal cord monitoring in scoliosis surgery in patients with cerebral palsy.
abstract: Although spinal cord monitoring is recommended during scoliosis surgery, a review from Rancho Los Amigos Medical Center stated that they were only able to obtain reproducible tracings in 53% of cerebral palsy patients. To ascertain that monitoring is both feasible and reliable in these patients, we reviewed the records of 34 consecutive patients with cerebral palsy who had scoliosis surgery at our institution. Spinal cord function was monitored by recording peripheral nerve, cervical/brainstem, and cortical somatosensory evoked potentials to posterior tibial nerve stimulation. Reproducible tracings were achieved in 31 of the 34 patients. Significant intraoperative changes were recorded in 12 of the 31 monitored patients, usually related to and requiring some modifications of the instrumentation. We conclude that with careful technique, spinal cord monitoring using cervical/brainstem somatosensory evoked potentials can be reliably achieved in most patients with cerebral palsy undergoing scoliosis surgery.
authors.affiliation: Division of Orthopaedics, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Ecker
authors.forename: J P
authors.initials: JP
authors.lastname: Dormans
authors.forename: D M
authors.initials: DM
authors.lastname: Schwartz
authors.forename: D S
authors.initials: DS
authors.lastname: Drummond
authors.forename: W A
authors.initials: WA
authors.lastname: Bulman
mesh_terms: D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000150:complications* / Q000503:physiopathology; D002648:Child; D005069:Evaluation Studies as Topic; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007866:Leg / Q000503:physiopathology; D008297:Male; D016343:Monitoring, Intraoperative; D009068:Movement; D011184:Postoperative Period; D012600:Scoliosis / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D013116:Spinal Cord / Q000503:physiopathology*; D016138:Walking