Protocolo de monitorizacion neurofisiológica intraoperatoria de la médula espinal

Abstract

The consequences derived from medullar harm caused during several spinal cord surgical interventions can often be catastrophic for the patient, even more taking into consideration that many of them are young. This problem is observed specially at interventions of spinal malformations (kyphoscoliosis), but also during other surgical techniques like fractures, degenerations, spinal tumors and aortic lesions. The use of somatosensory evoked potentials (SEP) began at late 70's, as a method to monitorize spinal cord function during surgery; years later, motor evoked potentials (MEP) joined this option, giving us direct information about the functioning of posterior spinothalamic tract (posterior column) and lateral corticospinal tract (pyramidal tract), respectively. This has motivated that, although the degree of surgical difficulty and complexity of spinal instrumentation have raised, the actual percentage of neurological complications derived from them has decreased. This article describes the intraoperative spinal cord monitoring protocol followed at Hospital Clínico San Carlos of Madrid, Spain, which includes the making of SEP and MEP, the latest according to the translaminar stimulation technique.