title: Neurophysiological assessment of the injured spinal cord: an intraoperative approach.
abstract: METHODS
  Prospective, observational study.
  
  
  OBJECTIVE
  To assess the spinal cord function intraoperatively in subjects during spine stabilization for spinal cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials (e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials (e-SEPs) and predicting the outcome of spinal cord injury (SCI).
  
  
  METHODS
  Regional Trauma Center, Torino, Italy.
  
  
  METHODS
  Fifty-five patients were intraoperatively studied during posterior spine stabilization surgery for traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI-6 of them with central cord syndrome and 1 with central cord plus Brown Sequard syndrome-and 20 patients were neurologically uncompromised.
  
  
  RESULTS
  The neurophysiologic profile of the complete SCI was the absence of both m-MEPs and e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs cranially to the lesion site. None of these patients recovered motor function in the follow-up. A clearly detectable caudal D wave was associated with motor recovery even in deeply paraparetic patients. In one neurologically incomplete patient a reversible deterioration of m-MEPs and e-MEPs was observed during the compression-distraction manoeuvre.
  
  
  CONCLUSIONS
  Intraoperative neurophysiological evaluation of SCI patients can provide information about spinal cord function that is not retrievable by other clinical means and can correctly predict neurological outcome. Intraoperative testing during early stabilization of the spine of deeply paraparetic SCI patients provides additional information about their neurological profile.
authors.affiliation: 1] Section of Clinical Neurophysiology, CTO, Torino, Italy [2] Department of Neurosciences, Città della Salute e della Scienza, Torino, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Costa
authors.affiliation: 1] Department of Neurosciences, Città della Salute e della Scienza, Torino, Italy [2] Neurosurgery, CTO, Torino, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Faccani
authors.affiliation: Neurosurgery, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Sala
authors.affiliation: Department of Neurosciences, Città della Salute e della Scienza, Torino, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Montalenti
authors.affiliation: 1] Section of Clinical Neurophysiology, CTO, Torino, Italy [2] Department of Neurosciences, Città della Salute e della Scienza, Torino, Italy.
authors.forename: M L
authors.initials: ML
authors.lastname: Giobbe
authors.affiliation: Department of Intraoperative Neurophysiology, St Luke's Roosevelt Hospital, Mount Sinai Health System, New York, NY, USA.
authors.forename: V
authors.initials: V
authors.lastname: Deletis
mesh_terms: D000328:Adult; D000368:Aged; D019054:Evoked Potentials, Motor; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D020127:Recovery of Function; D013116:Spinal Cord / Q000503:physiopathology / Q000601:surgery; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult