Spinal cord monitoring in scoliosis surgery using an epidural electrode. Results of a prospective, consecutive series of 191 cases.
METHODS
Retrospective analysis of a prospectively accrued series of 191 consecutive patients who underwent intraoperative neurophysiologic monitoring during scoliosis corrective surgery.


OBJECTIVE
To compare the monitoring outcome of idiopathic and neuromuscular scoliosis. To demonstrate the usefulness of the epidural electrode. To report sensitivity and specificity of the monitoring method employed at a single institution.


BACKGROUND
Reports in the literature emphasized the difficulty to obtain data in neuromuscular patients. Multimodality spinal cord monitoring has been recommended. Despite their still debated composition, neurogenic motor-evoked potentials have proven their validity in clinical practice.


METHODS
Somatosensory and neurogenic evoked potentials were attempted in all patients presenting for scoliosis correction between 1999 and 2005. Study patients were divided into 3 groups: group 1, idiopathic; group 2, neuromuscular; and group 3, miscellaneous origins.


RESULTS
The use of the epidural electrode demonstrated significant usefulness in the ability of monitoring otherwise nonmonitored patients, especially in group 2. Inability to obtain any evoked potentials occurred in 4 cases (2.1%). Five cases were found to be true positives. An adapted and rapid intervention permitted to avoid new postoperative deficit in all cases. There was no instance of false-negative data. The overall method sensitivity was 100%, and specificity was 52.69%.


CONCLUSIONS
The use of a single epidural electrode allowing somatosensory evoked potentials recording and spinal cord stimulation alternately is a safe and valid method of intraoperative monitoring.
Accadbled
Franck
F
Department of Pediatric Orthopedic Surgery, Children's Hospital, Toulouse, France. faccadbled@wanadoo.fr
Henry
Patrice
P
de Gauzy
Jérôme Sales
JS
Cahuzac
Jean Philippe
JP
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004558:Electric Stimulation / Q000379:methods; D004566:Electrodes; D004824:Epidural Space / Q000502:physiology*; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012600:Scoliosis / Q000503:physiopathology / Q000601:surgery*; D013116:Spinal Cord / Q000502:physiology* / Q000601:surgery*