Cortical somatosensory-evoked potentials during spine surgery in patients with neuromuscular and idiopathic scoliosis under propofol–remifentanil anaesthesia

Abstract

Intraoperative monitoring of the spinal cord via cortical somatosensory-evoked potentials (SSEP) is a routine during spinal surgery. However, especially in neuromuscular scoliosis, the reliability of cortical SSEP has been questioned. Therefore, we compared the feasibility of cortical SSEP in idiopathic and neuromuscular scoliosis using anaesthetics known to have only minimal effect on SSEP recordings. Total intravenous anaesthesia with propofol and remifentanil as continuous infusion was standardized for all the patients. Median and tibial nerve cortical SSEP were monitored in 54 patients who underwent surgery for spinal deformity. Twenty-seven had idiopathic scoliosis and 27 had neuromuscular scoliosis. The portion of reproducible results and intraoperative changes were compared between the groups. In both groups, cortical SSEP could be monitored with sufficient reliability. Only in two patients with idiopathic and four patients with neuromuscular scoliosis no reproducible traces could be obtained. The amplitudes in patients with neuromuscular scoliosis were lower than in those with idiopathic scoliosis, but not statistically significant. There were no postoperative neurological deficits. The number of false positive and true positive did not differ between the groups. Assessment of cortical SSEP during spine surgery was equally effective and reliable in patients with neuromuscular scoliosis and in patients with idiopathic scoliosis, possibly as a result of propofol-remifentanil anaesthesia.