Abstract
Intraoperative electrophysiological monitoring is used in a variety of procedures. Various techniques are thought to be useful for the detection and prevention of neurological deficits [1,2]. Mechanisms of thoraco-lumbar spinal cord injury during scoliosis surgery include ischemia and over-distraction of vertebral column. This injury can be potentially detected by standard tibial somatosensory evoked potentials (SSEPs) thus reducing the risk of permanent paraplegia [35]. However, SSEPs only detect sensory tracts dysfunction and motor deficits can occur without any SSEP changes [6,7]. Motor evoked potentials (MEP), obtained by transcranial cortical stimulation, can provide an early detection of motor disturbance [8-10]. The combined methods can improve the sensitivity and specificity of the monitoring [11].
Highlights
Intraoperative electrophysiological monitoring is used in a variety of procedures
Somatosensory evoked potentials (SSEPs) monitoring serves as an early warning system to detect injury intraoperatively
somatosensory evoked potentials (SSEPs) monitoring is performed to assess the functional status of peripheral nerves and sensory tracts in the spinal cord
Summary
Mechanisms of thoraco-lumbar spinal cord injury during scoliosis surgery include ischemia and over-distraction of vertebral column. This injury can be potentially detected by standard tibial somatosensory evoked potentials (SSEPs) reducing the risk of permanent paraplegia [35]. Somatosensory evoked potentials (SSEPs) monitoring serves as an early warning system to detect injury intraoperatively. SSEP monitoring is performed to assess the functional status of peripheral nerves and sensory tracts in the spinal cord. Intraoperative monitoring equipment consists of three systems: stimulus, recording, and data storage. Stimulation is applied to the spinal cord and the descending sensory volley is recorded from the nerves in the extremities [14,15]. Since cortical stimulation, in non-paralyzed patient, can cause severe jaw musculature contraction, adequate measures should be taken to prevent tongue and teeth damage
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