SSEP monitoring during pelvic and acetabular fracture surgery

Forty-one consecutive patients requiring surgery for pelvic or acetabular fractures were reviewed to compare the 20 patients (20 fractures) who had SSEP monitoring to the twenty-one patients (22 fractures) in whom monitoring was not available. In the unmonitored group, five patients had a preoperative neurologic deficit (three major/two minor), whereas in the monitored group there were nine patients with deficits (two major/seven minor). Intraoperatively, significant somatosensory evoked potential (SSEP) changes occurred in six of the monitored patients. In five patients the changes resolved on correction of the offending action and there was no postoperative deficit. In the remaining case, SSEP changes did not resolve and the patient awoke with a peroneal palsy. This one monitored patient with a new deficit compares with five patients with postoperative new deficits (or deteriorations) in the unmonitored group. The majority of intraoperative SSEP changes and iatrogenic deficits occurred during surgery through the ilioinguinal approach. During follow-up, the great majority of deficits resolved completely or had significant improvement.