title: Spinally elicited peripheral nerve responses are sensory rather than motor.
abstract: OBJECTIVE
  Spinally elicited peripheral nerve responses, commonly called neurogenic motor evoked potentials (NMEPs), are widely used to monitor spinal cord motor function during surgery. However, numerous evidence suggests that these responses are primarily sensory rather than motor. The collision technique was utilized to address this issue.
  
  
  METHODS
  Collision studies were performed in 7 patients during surgery. An ascending volley of sensory (AS) and motor activity (AM) was elicited by posterior tibial nerve stimulation at the popliteal fossa. After a short time delay, high cervical spinal stimulation produced a descending volley of sensory (DS) and motor (DM) activity. The AM volley ascended only to the anterior horn cells whereas the AS and DS volleys collided in the spinal cord. The inter-stimulus delays were varied so as to affect the degree of spinal cord collision. The DS and DM activity which remained after collision was recorded from the posterior tibial nerves at the ankle.
  
  
  RESULTS
  Inter-stimulus delays of 18 ms or less resulted in no apparent peripheral descending volleys. These findings were consistent for all the patients studied.
  
  
  CONCLUSIONS
  Spinally elicited peripheral nerve responses are primarily sensory rather than motor and are mediated by the same neural pathways as SEPs.
authors.affiliation: Hughston Sports Medicine Hospital, Columbus, USA. toleikis@mindspring.com
authors.forename: J R
authors.initials: JR
authors.lastname: Toleikis
authors.forename: J P
authors.initials: JP
authors.lastname: Skelly
authors.forename: A O
authors.initials: AO
authors.lastname: Carlvin
authors.forename: J K
authors.initials: JK
authors.lastname: Burkus
mesh_terms: D000293:Adolescent; D002648:Child; D004558:Electric Stimulation; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative; D009046:Motor Neurons / Q000502:physiology*; D009475:Neurons, Afferent / Q000502:physiology*; D012600:Scoliosis / Q000601:surgery; D013116:Spinal Cord / Q000166:cytology* / Q000502:physiology* / Q000601:surgery