title: Somatosensory evoked potential monitoring of peripheral nerves during external fixation for limb lengthening and correction of deformity in children.
abstract: We undertook a retrospective analysis of 306   procedures on 233 patients, with a mean age of 12 years (1 to 21),   in order to evaluate the use of somatosensory evoked potential (SSEP)   monitoring for the early detection of nerve compromise during external   fixation procedures for limb lengthening and correction of deformity.   Significant SSEP changes were identified during 58 procedures (19%).   In 32 instances (10.5%) the changes were transient, and resolved   once the surgical cause had been removed. The remaining 26 (8.5%)   were analysed in two groups, depending on whether or not corrective   action had been performed in response to critical changes in the   SSEP recordings. In 16 cases in which no corrective action was taken,   13 (81.2%, 4.2% overall) developed a post-operative neurological   deficit, six of which were permanent and seven temporary, persisting   for five to 18 months. In the ten procedures in which corrective   action was taken, four patients (40%, 1.3% overall) had a temporary   (one to eight months) post-operative neuropathy and six had no deficit. After appropriate intervention in response to SSEP changes, the   incidence and severity of neurological deficits were significantly   reduced, with no cases of permanent neuropathy. SSEP monitoring   showed 100% sensitivity and 91% specificity for the detection of   nerve injury during external fixation. It is an excellent diagnostic   technique for identifying nerve lesions when they are still highly   reversible.
authors.affiliation: Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, Texas 75019, USA. marina.makarov@tsrh.org
authors.forename: M R
authors.initials: MR
authors.lastname: Makarov
authors.forename: M L
authors.initials: ML
authors.lastname: Samchukov
authors.forename: J G
authors.initials: JG
authors.lastname: Birch
authors.forename: A M
authors.initials: AM
authors.lastname: Cherkashin
authors.forename: S P
authors.initials: SP
authors.lastname: Sparagana
authors.forename: M R
authors.initials: MR
authors.lastname: Delgado
mesh_terms: D000293:Adolescent; D001852:Bone Lengthening; D002648:Child; D002675:Child, Preschool; D005073:Evoked Potentials, Somatosensory; D016267:External Fixators; D005260:Female; D006801:Humans; D007223:Infant; D017880:Limb Deformities, Congenital / Q000601:surgery*; D008297:Male; D016343:Monitoring, Intraoperative; D059348:Peripheral Nerve Injuries / Q000517:prevention & control*; D012189:Retrospective Studies