Intraoperative control by somatosensory evoked potentials in the treatment of cervical myeloradiculopathy. Results in 210 cases.
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 false-negatives 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.
Sebastián
C
C
Spinal Surgery Unit, Parque San Antonio Clinic, Malaga, Spain.
Raya
J P
JP
Ortega
M
M
Olalla
E
E
Lemos
V
V
Romero
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae; D018450:Disease Progression; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D006801:Humans; D016268:Internal Fixators; D007902:Length of Stay; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D017887:Ossification of Posterior Longitudinal Ligament / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D011843:Radiculopathy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015203:Reproducibility of Results; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods