Multimodality monitoring of transcranial electric motor and somatosensory-evoked potentials during surgical correction of spinal deformity in patients with cerebral palsy and other neuromuscular disorders.
METHODS
This prospective, descriptive study determined the reliability of transcranial electric motor and posterior tibial nerve somatosensory-evoked potentials in children with neuromuscular scoliosis.


OBJECTIVE
To assess the applicability of transcranial electric motor and posterior tibial nerve somatosensory-evoked potentials during surgical correction of neuromuscular scoliosis, particularly with cerebral palsy-related deformity.


BACKGROUND
During corrective spinal surgery for neuromuscular scoliosis, intraoperative multimodality spinal cord monitoring is recommended. There exist conflicting, retrospective studies regarding the reliability of spinal cord monitoring in patients with neuromuscular scoliosis.


METHODS
Transcranial electric motor potentials and posterior tibial nerve somatosensory-evoked potentials were monitored in all patients presenting for spinal fusion between 2000 and 2001. Anesthesia was standardized for all patients.


RESULTS
There were 68 patients subdivided into two subject groups. Group I consisted of 39 patients with neuromuscular scoliosis associated with cerebral palsy, and Group II consisted of 29 children with neuromuscular scoliosis due to a disease process other than cerebral palsy. Five of the 68 patients had significant amplitude changes in 1 or both monitoring methods during surgery relative to baseline. Of these, one had permanent neurologic deficit despite standard intervention. Somatosensory-evoked potentials were monitored successfully in 82% of the cerebral palsy and 86% of the noncerebral palsy patients. Transcranial electric motor-evoked potentials, on the other hand, were monitorable in 63% of patients with mild or moderate degrees of cerebral palsy and 39% of those with severe involvement. Eighty-six percent of those with noncerebral palsy-related neuromuscular scoliosis had recordable motor-evoked potentials at baseline.


CONCLUSIONS
Both transcranial electric motor and posterior tibial nerve somatosensory-evoked potentials can be monitored reliably in most patients with neuromuscular scoliosis. Those with severe cerebral palsy present the greatest challenge to successful neurophysiologic monitoring.
DiCindio
Sabina
S
Department of Anesthesiology and Critical Care Medicine, Nemours Children's Clinic-Wilmington, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19803, USA. sdicindi@nemours.org
Theroux
Mary
M
Shah
Suken
S
Miller
Freeman
F
Dabney
Kirk
K
Brislin
Robert P
RP
Schwartz
Daniel
D
D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D009468:Neuromuscular Diseases / Q000503:physiopathology* / Q000601:surgery; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery