Conduction properties of epidurally recorded spinal cord potentials following lower limb stimulation in man

Abstract

Spinal somatosensory evoked potentials were recorded in 35 neurologically normal patients undergoing surgery for scoliosis. During posterior procedures the recording electrodes were placed in the dorsal epidural space and during anterior operations in the intervertebral discs. Stimulation was of the tibial nerve in the popliteal fossa and the posterior tibial and sural nerves at the ankle. At thoracic levels the response consisted of at least 3 components with different peripheral excitation thresholds and spinal conduction velocities (range 35-85 m/sec). All components were conducted mainly in tracts ipsilateral to the stimulus, component 1 being most laterally located. At low stimulus intensity only the fastest activity was recorded but this was markedly delayed over low thoracic segments and was recorded as a repetitive discharge rostrally. Higher intensities elicited additional components which were conducted at a slower but relatively uniform velocity; consequently they might overlap with or even overtake the fast activity at mid-to-low thoracic levels. Component 1 was much less prominent when the posterior tibial nerve was stimulated at the ankle and absent from the (cutaneous) sural nerve response; remaining potentials were conducted at velocities similar to those of components 2 and 3 following tibial nerve stimulation at the knee. Small 'stationary' potentials were recorded at all thoracic levels, probably due to the change in conductivity as the volley entered the spinal cord. Efferent activity was recorded at and below the thoraco-lumbar junction, possibly related to the H-reflex or F-wave. Similar, although smaller, afferent potentials were recorded from the anterior side of the vertebral column. Component 1 is likely to be due to the stimulation of group 1 muscle afferents which terminate in the dorsal horn and activate second order neurones, many of whose axons go to form the ipsilateral dorsal spinocerebellar tract. Components 2 and 3 are believed to be largely cutaneous in origin and to be conducted mainly in the dorsal columns.