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Combined effects of compression and hypotension on nerve root function. A clinical case
W F Krengel1, L R Robinson, V A Schneider
1Department of Orthopedic Surgery, University of Washington, Seattle.
Spine
|February 1, 1993
Summary
Mild nerve root compression combined with hypotension during spinal surgery can impair nerve function. This study shows that reduced blood pressure significantly impacts nerve root signals, highlighting risks during spinal procedures.
Area of Science:
- Neurosurgery
- Spinal Cord Injury
- Neurology
Background:
- Animal studies suggest nerve root compression exacerbates hypotension effects.
- This case investigates a patient with an L2 burst fracture undergoing surgical reduction and distraction.
Observation:
- Sensory-evoked potentials were monitored during surgery with induced hypotension.
- A significant drop in right femoral evoked potential amplitude occurred with hypotension, while other responses remained stable.
Findings:
- Hypotension selectively reduced right femoral nerve root evoked potential amplitude.
- Evoked potential changes were reversible upon normalizing blood pressure.
- A strong correlation was found between right femoral evoked potential amplitude and systolic blood pressure.
Implications:
- Provides clinical evidence for additive adverse effects of hypotension and local compression on nerve root function.
- Highlights the importance of monitoring nerve root function during spinal surgery involving hypotension and potential compression.
- Suggests that selective vulnerability of nerve roots to combined insults may exist.