title: Validity and utility of monopolar spinal cord stimulation in pediatric scoliosis surgery.
abstract: To assess the validity and utility of monopolar stimulation (between a peridural needle and a large adhesive anode placed in the sternal area) for intraoperative monitoring in scoliosis surgery.
  
  
  
  This procedure was assessed during 41 operations involving either arthrodesis with posterior instrumentation or a Vertical Expandable Prosthetic Titanium Rib (VEPTR). Responses evoked by monopolar stimulation were compared with those evoked by bipolar stimulation between two epidural needle electrodes. Potentials evoked by monopolar stimulation in the upper limbs were compared with those evoked in the lower limbs during the same stimulation procedure.
  
  
  
  Monopolar stimulation yielded equivalent and, if anything, more stable responses in the lower limbs. Recording in the upper limbs was satisfactory and allowed a decrease in responses to be detected in two patients. Acceptable thresholds for changes in amplitude relative to baseline were 40 % for upper limbs and 30 % for lower limbs.
  
  
  
  Monopolar stimulation can be used to monitor the spinal cord during surgery for scoliosis correction. This procedure is more convenient for the surgeon and allows for the combined recording of responses in all four limbs, which can be useful in the case of surgical techniques such as those involving a VEPTR.
authors.affiliation: Department of Neurophysiology, Rennes University Hospital, 35033, Rennes, France.
authors.forename: Constantin
authors.initials: C
authors.lastname: Gomes
authors.affiliation: Department of Neurophysiology, Rennes University Hospital, 35033, Rennes, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Kuchenbuch
authors.affiliation: Department of Pediatric Orthopedic Surgery, Rennes University Hospital, 35033, Rennes, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Lucas
authors.affiliation: "Behavior and Basal Ganglia" Research Unit (EA 4712), EA 4712 "Comportement et Noyaux Gris Centraux", Faculté de Médecine, Université de Rennes 1, Avenue Léon Bernard, 35043, Rennes, France.
authors.forename: Soizic
authors.initials: S
authors.lastname: Argaud
authors.affiliation: Department of Pediatric Orthopedic Surgery, Rennes University Hospital, 35033, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Violas
authors.affiliation: Department of Neurophysiology, Rennes University Hospital, 35033, Rennes, France. paul.sauleau@univ-rennes1.fr.|"Behavior and Basal Ganglia" Research Unit (EA 4712), EA 4712 "Comportement et Noyaux Gris Centraux", Faculté de Médecine, Université de Rennes 1, Avenue Léon Bernard, 35043, Rennes, France. paul.sauleau@univ-rennes1.fr.
authors.forename: Paul
authors.initials: P
authors.lastname: Sauleau
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019054:Evoked Potentials, Motor; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D012600:Scoliosis / Q000601:surgery*; D062187:Spinal Cord Stimulation; D013123:Spinal Fusion
keywords: Monopolar stimulation; NMEP; Scoliosis surgery; Spinal cord monitoring; VEPTR