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Cotrel-dubousset instrumentation in children using simultaneous motor and somatosensory evoked potential monitoring
J P Stephen1, M R Sullivan, R G Hicks
1Department of Orthopedic Surgery, Prince of Wales Hospital, Sydney, Australia.
Insights
This study demonstrates a safe and reliable spinal cord monitoring system for scoliosis surgery, successfully recording combined motor- and somatosensory-evoked potentials in children without special anesthetic regimens, eliminating the need for wake-up tests.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Neurophysiology
Background:
- Existing spinal cord monitoring techniques for scoliosis surgery often require special anesthetic regimens.
- Current methods may assess only limited spinal cord areas or monitor motor and somatosensory functions separately.
Purpose of the Study:
- To evaluate a novel technique for simultaneously monitoring motor- and somatosensory-evoked potentials during scoliosis surgery.
- To determine the efficacy and safety of this combined evoked potential monitoring method in pediatric patients.
Main Methods:
- Prospective recording of combined motor- and somatosensory-evoked potentials in children undergoing scoliosis surgery.
- Utilized epidural leads for simultaneous recording of descending motor volleys (transcranial electrical stimulation) and ascending somatosensory volleys (tibial nerve stimulation).
- No special anesthetic or muscle relaxant regimens were employed.
Main Results:
- Successful recording of combined evoked potentials in 81% (138/160) of pediatric patients.
- Evoked potential waveform changes occurred in 5% (8/160) but were successfully managed.
- Satisfactory curve correction was achieved with no new postoperative neurological deficits.
Conclusions:
- The described spinal cord monitoring system is safe, reliable, and accurate for scoliosis surgery.
- This technique obviates the need for the traditional intraoperative wake-up test.
- Simultaneous monitoring of motor and somatosensory evoked potentials enhances surgical safety in pediatric scoliosis correction.
Study Design:
To record prospectively combined motor- and somatosensory-evoked potentials in children during scoliosis surgery using Cotrel-Dubousset instrumentation, without using special anesthetic or muscle relaxant regimens.
Objective:
To determine the outcome of scoliosis surgery guided by a new technique of monitoring motor- and somatosensory-evoked potentials simultaneously.
Summary Of Background Data:
Other techniques used to assess cord function generally are limited by special anesthetic requirements or assess only a limited part of the cord or monitor motor function separately from somatosensory function.
Methods:
Spinal cord function was monitored using epidural leads to record simultaneously the descending motor volley (by transcranial electrical stimulation) and the ascending somatosensory volley (by tibial nerve stimulation) at two spinal levels.
Results:
Combined motor- and sensory-evoked potentials were recorded successfully in 138 of 160 children (81%). Changes in evoked potential waveforms were seen in eight patients (5%), but resolved or lessened in response to appropriate measures. Curve correction was satisfactory, and there were no new postoperative deficits or worsening of preexisting deficits in any patient.
Conclusion:
A spinal cord monitoring system is described that is safe, reliable, accurate, and makes it unnecessary to resort to the "wake-up" test.