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Neurophysiological monitoring of spinal cord function during instrumented anterior cervical fusion
Bikash Bose1, Anthony K Sestokas, Daniel M Schwartz
1Surgical Monitoring Associates, Inc., 25 Bala Ave., Suite 105, Bala Cynwyd, PA 19004, USA. ranal@msn.com
Background Context:
Somatosensory evoked potentials (SSEPs) monitor global spinal cord function, and the interpretation of motor loss is based on inferred rather than direct measurements. Therefore, SSEPs may not be useful for identifying motor function deficits caused by anterior spinal column injury or nerve root injury during decompression or placement of instrumentation. For these reasons, adjunctive methods for monitoring may be especially useful during cervical spine surgery.
Purpose:
To evaluate the effectiveness of SSEP and transcranial electrical motor evoked potential (tceMEP) monitoring of spinal cord function during anterior fusion of the cervical spine.
Study Design/Setting:
Retrospective review.
Patient Sample:
Consecutive instrumented, anterior cervical spine surgeries performed by the same surgeon at a single institution for 119 patients.
Outcome Measures:
Record of neurophysiological alerts during surgery and record of postoperative neurological deficits not present before surgery.
Methods:
Spinal cord function was monitored intraoperatively with recordings of ulnar and posterior tibial nerve SSEPs and tceMEPs.
Results:
Six neurophysiologic alerts occurred that prompted surgeon and/or anesthesiologist intervention. Three patients developed new motor weakness after surgery. One patient had temporary right-leg weakness that was predicted accurately by the disappearance of the right lower extremity tceMEPs. One patient had additional temporary postoperative compromise of the right C5-C6 spinal nerve roots that could not be detected intraoperatively because of absent baseline tceMEPs from the affected muscles. For one patient who developed quadriparesis postoperatively, tceMEP monitoring was precluded by the excessive use of neuromuscular blockade during the procedure.
Conclusions:
The results illustrate the potential utility of intraoperative SSEPs and the tceMEPs for detection of changes in spinal cord function related to patient positioning and hemodynamic effects during anterior cervical fusion.