A system for the electrophysiological monitoring of the spinal cord during operations for scoliosis

Abstract

An electrophysiological system for monitoring the spinal cord during operations for scoliosis is described. During the development of the technique the recording of cortical somatosensory evoked potentials from the scalp and spinal somatosensory evoked potentials from the laminae or spines was superseded by the positioning of recording electrodes in the epidural space cephalad to the area to be fused. All recordings were made in response to stimulation of the posterior tibial nerve at the knee. Results in 138 patients are presented and the findings in three patients who exhibited neurological deficits after operation are described. It is concluded that spinal somatosensory evoked potentials are sensitive to minor spinal cord impairment, possible due to ischaemia, and that these changes may be reversed when the cause is quickly remedied. The monitoring system interferes minimally with anaesthetic and surgical procedures and is now performed as a routine.