Continuous neural monitoring in lumbar spine surgery: experience with 101 patients

The first report about lumbar spinal surgery under epidural anesthesia has been published in 1958. The aim of this study was assess to epidural anesthesia as a regional operative anesthesia in lower lumbar spine surgery and to use the opportunity of verbal interaction with the patient who is able to move her/his lower extremities voluntarily during surgery. We called this simultaneous clinical assessment process as continuous neural monitoring. Established pathologies in the patients were as follows; lumbar herniated intervertebral disc disease (n = 95), lumbar spondylolisthesis (n = 4), lumbar lamina fracture (n = 1) and lumbar dumbbell Ewing's sarcoma (n = 1). Preoperative findings, operative findings, operative complications, postoperative complications and short-term results were assessed by the surgeon-anesthesiologist team. The patients, 99 out of 101, were followed-up for more than 15 months (mean 21.2 months). Fair and failure results were assessed in 7.0 % of the patients. Even though epidural anesthesia is almost equal to general anesthesia in terms of anesthetic complications, surgical complications and surgical results in uncomplicated lumbar spinal surgery cases, it has the advantage of being able to simultaneously evaluate motor results of surgical maneuvers and/or manipulations on the neural structures. This advantage, which is not available at the same accuracy with other neurophysiologic monitoring modalities, would be valuable in complex lumbar spine surgery cases.