Intraoperative detection of spinal cord ischemia using somatosensory cortical evoked potentials during thoracic...

Paraplegia remains a devastating and unpredictable complication of surgical procedures requiring temporary occlusion of the thoracic aorta, interruption of important spinal radicular vessels, or both. Intraoperative monitoring of the physiological integrity of the spinal cord should permit the early detection of spinal cord ischemia, the judicious and timely institution of corrective measures, including bypass or shunting, and the preservation of important intercostal arteries in appropriate circumstances. A model of spinal cord ischemia was created by temporary proximal and distal occlusion of the canine thoracic aorta. Serial measurement of somatosensory cortical evoked potentials (SCEP) generated by peripheral nerve stimulation, reflecting the status of long-tract neural conduction, was used to monitor alterations in spinal cord function during ischemia. Twelve animals subjected to aortic occlusion demonstrated a characteristic time-related deterioration of the SCEP with virtual extinction of the signal at a mean interval (+/- standard error of the mean) of 12.4 +/- 1.5 minutes. Six animals in which reperfusion was established immediately following the loss of the SCEP (Group 1) demonstrated complete recovery without neurological sequelae, as assessed by clinical and histological criteria. In 6 animals (Group 2), the period of aortic occlusion was extended for an additional 15 minutes following loss of the SCEP (27.3 +/- 2.3 minutes); postoperatively, 4 of 6 animals sustained major neurological lesions characterized by spastic paraplegia and histological evidence of spinal cord infarction (Group 1 versus Group 2, p less than 0.05). We conclude that distinctive alterations in the SCEP are indicative of reversible ischemic spinal cord dysfunction. On-line monitoring of spinal cord function using the technique of SCEP provides a rational basis for determining of SCEP provides a rational basis for determining operative strategy during surgical procedures on the thoracic aorta.