title: Intraoperative dermatomal evoked potential monitoring fails to predict outcome from lumbar decompression surgery.
abstract: METHODS
  Thirty-three patients with single-level, unilateral lumbosacral radiculopathy underwent micro-decompression and intraoperative dermatomal evoked potential monitoring. Side-to-side latency asymmetry was calculated. A criteria for "abnormal" was defined. Intraoperative dermatomal evoked potentials were obtained before and after decompression. The changes were correlated with clinical outcome at the 3-month follow-up examination.
  
  
  OBJECTIVE
  To determine whether intraoperative dermatomal evoked potential latency asymmetry confirms nerve root compression and whether an improvement of latency asymmetry after decompression predicts a good clinical outcome.
  
  
  BACKGROUND
  Intraoperative dermatomal evoked potential has been proposed as a test to assess the adequacy of nerve root decompression. Initial reports suggested improvement of dermatomal evoked potential amplitude and latency after decompression. The clinical efficacy is controversial because of its technical difficulty and inherent variation.
  
  
  METHODS
  Cervical recording was chosen to reduce the effects of anesthesia. The asymptomatic nerve root was used as a control. Quality of the tracings was determined by evoked potentials-to-noise amplitude ratio. Clinical outcome was based on patient's pain relief and satisfaction.
  
  
  RESULTS
  Tracings of acceptable quality were obtained at baseline in 57.6% (19 of 33) of patients. A side-to-side latency asymmetry > 5% was defined as abnormal. Before decompression, 68.4% (13 of 19) of patients had an abnormal dermatomal evoked potential. After decompression, latency asymmetry returned to normal in every patient. Clinical outcome was good or excellent in 13 patients, fair in four patients, and poor in two patients. Dermatomal evoked potential latency improvements were not related to variation in clinical outcome.
  
  
  CONCLUSIONS
  Intraoperative dermatomal evoked potential monitoring is technically demanding. Finding reproducible potentials is difficult. More research is necessary before general use of dermatomal evoked potentials for monitoring nerve root decompression.
authors.affiliation: University of California, Los Angeles, Comprehensive Spine Center, USA.
authors.forename: R Y
authors.initials: RY
authors.lastname: Tsai
authors.forename: R S
authors.initials: RS
authors.lastname: Yang
authors.forename: M R
authors.initials: MR
authors.lastname: Nuwer
authors.forename: L E
authors.initials: LE
authors.lastname: Kanim
authors.forename: R B
authors.initials: RB
authors.lastname: Delamarter
authors.forename: E G
authors.initials: EG
authors.lastname: Dawson
mesh_terms: D000328:Adult; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D009408:Nerve Compression Syndromes / Q000175:diagnosis / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013126:Spinal Nerve Roots / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome