Impact of somatosensory evoked potential monitoring on cervical surgery

Controversy still exists about the necessity of somatosensory evoked potential (SSEP) monitoring during cervical surgery. The purpose of this prospective study is to determine the impact of SSEP monitoring on anterior cervical surgery. Intraoperative SSEP monitoring was performed in 100 patients treated by an anterior cervical approach. The patients were divided into three groups according to their preoperative clinical condition. Somatosensory evoked potential monitoring was performed during five stages of the procedure: M1, after the induction of anesthesia; M2, during positioning; M3, during distraction of the intervertebral space; M4, throughout decompression; and M5, during graft placement. Normal SSEPs were obtained during M1 from all the patients in group 2. Pathologic SSEPs were recorded at M1 in 45 patients from group 1. No SSEPs were recorded at M1 in six patients in group 3. A deterioration of the SSEPs was observed in 35 patients during M2. Deteriorated SSEPs were observed during M3 in 14 patients. No deterioration of the SSEPs was recorded during M4. Intraoperative SSEP monitoring is easy to perform and helps to increase safety during anterior cervical surgery. Critical phases of the surgical procedure were identified and the surgical strategy was modified as a result of this study.