Evoked-potential monitoring during dorsal root entry zone surgery. Patients with chronic pain

Somatosensory evoked potentials (SEP) were monitored intraoperatively in 15 patients who underwent spinal cord radiofrequency thermal dorsal root entry zone (DREZ) lesion procedures to treat chronic deafferentation pain. We found a significant correlation between transient latency shifts (recovery to prelesion values in the postlesioning period) of the first positive peak of the SEP (P1) during lesion production and the patients' subsequent postoperative neurological status (p less than 0.01). Transient increases in P1 latency above 2 ms were associated with detectable but transient postoperative sensorimotor deficits that resolved weeks to months after surgery. In 1 patient, the intraoperative P1 latency failed to return to baseline values; this patient had irreversible postoperative sensorimotor dysfunction. In 9 patients, we confirmed the value of recording bilateral SEP, using the contralateral side of the spinal cord (with no lesions) as a control. This experience has resulted in an improved SEP monitoring strategy: we now reconsider the risk-benefit ratio of additional DREZ lesions if early lesion production results in increased P1 latency. Rapid normalization of the P1 latency indicates that any postoperative deficits likely will resolve. Failure of P1 latency to return to control levels during the surgical wound closure period (approximately 1 h) indicates the high probability of permanent neurological deficits.