Human motor evoked potential responses following spinal cord transection: an in vivo study.
Motor evoked potential (MEP) monitoring has been used increasingly in conjunction with somatosensory evoked potential monitoring to monitor neurological changes during complex spinal operations. No published report has demonstrated the effects of segmental spinal cord transection on MEP monitoring. The authors describe the case of an 11-year-old girl with lumbar myelomeningocele and worsening thoracolumbar scoliosis who underwent a T11-L5 fusion and spinal transection to prevent tethering. Intraoperative MEP and somatosensory evoked potential monitoring were performed, and the spinal cord was transected in 4 quadrants. The MEPs were lost unilaterally as each anterior quadrant was sectioned. This is the first reported case that demonstrates the link between spinal cord transection and MEP signaling characteristics. Furthermore, it demonstrates the relatively minor input of the ipsilateral ventral corticospinal tract in MEP physiology at the thoracolumbar junction. Finally, this study further supports the use of MEPs as a specific intraoperative neuromonitoring tool.
Nair
M Nathan
MN
Department of Neurological Surgery, Children' Hospital and Regional Medical Center, University of Washington School of Medicine, Seattle, Washington 98105, USA.
Ramakrishna
Rohan
R
Song
Kit
K
Kinney
Gregory
G
Slimp
Jefferson
J
Ko
Andrew L
AL
Avellino
Anthony M
AM
D002648:Child; D019054:Evoked Potentials, Motor / Q000502:physiology*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007796:Laminectomy / Q000379:methods; D008159:Lumbar Vertebrae / Q000601:surgery; D008591:Meningomyelocele / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000379:methods*; D009436:Neural Tube Defects / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011712:Pyramidal Tracts / Q000502:physiology; D012600:Scoliosis / Q000601:surgery; D013116:Spinal Cord / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery