Monitoring the spinal cord during surgery for cervical myelopathy

Abstract

This chapter evaluates the evidence for the effectiveness of the spinal cord monitoring during the surgery performed for cervical spinal cord decompression due to skeletal deformity, or degeneration rather than tumor or arteriovascular abnormalities. It includes the effects of spondylosis, stenosis, disk protrusion, and subluxation. The chapter reviews that the patients undergoing decompressive surgery for longstanding cervical myelopathy are at a greater risk of iatrogenic neurological impairment than those receiving similar treatment for radicular lesions or acute spinal problems. Somatosensory evoked potentials (SEP) monitoring using noninvasive techniques are capable of detecting majority of the problems that arise during surgery due to direct cord compression or ischemia. Although the evidence that SEP monitoring actually helps prevent the exacerbation of cervical myelopathy is inconclusive, the opinion of most surgeons/authors is that the information provided is frequently helpful. The chapter also explores that electrophysiological monitoring of the cervical motor pathways by transcranial electrical stimulation is feasible, but there is no real evidence as to its effectiveness.