Copyright
©The Author(s) 2015.
World J Clin Cases. Sep 16, 2015; 3(9): 765-773
Published online Sep 16, 2015. doi: 10.12998/wjcc.v3.i9.765
Published online Sep 16, 2015. doi: 10.12998/wjcc.v3.i9.765
Table 1 Summary of advantages and disadvantages of each monitoring technique
Advantages | Disadvantages | |
SCEP | Easy to record using very simple hardware | The electrode used to deliver stimulation to the spinal cord should be located in the epidural space and the recording electrode in the intrathecal space |
Provides real-time information because its potentials are large enough without averaging | The malposition of the electrode can occur | |
Previous scarring can sometimes impair electrode placement | ||
SEP | Broadly available | Does not directly monitor corticospinal tract. Only assess the functional integrity of spinal cord dorsal columns. In the case of anterior spinal artery syndrome, postoperative paraplegia despite intraoperative SEP preservation has been reported |
Easy to implement | When approaching the intramedullary tumor during the initial dorsal myelotomy, SEPs can completely disappear | |
Has no contraindications | SEP recording requires signal averaging, which results in a time delay until data interpretation can generate a response to the surgeon. Therefore, an injury can be irreversible before it is even detected | |
Can be combined with other monitoring techniques | ||
Allows continuous monitoring throughout case | ||
Excellent specificity (approaching 100%) | ||
Neurogenic | Fast and easy to implement | Their specificity remains relative because they correspond to the joined activation of motor and sensory pathways |
MEP | Resistant to most anesthetics | Require curarization |
Sensitive in detecting a lesion | The terminal medullary cone is not monitored | |
In case of alert, the lesional level can be determined by displacing the stimulation electrode along the intervertebral spaces | ||
D waves | Very rapid acquisition | The recording electrode is in the surgical field and its use by the surgeon can produce artifacts |
D waves are specific of motor pathways | Laterality cannot be distinguished | |
They can establish a lesional level by displacing the spinal electrode along the intervertebral spaces | D waves cannot be used in small children, generally under 4 yr of age (incomplete maturation of motor path-ways) | |
D waves have prognostic value | Cannot be recorded below the level of T12 because there are not enough corticospinal tract fibers | |
Correlates most accurately with long-term motor function following | Previous scarring can sometimes impair electrode placement | |
intramedullary spinal cord tumor resection | ||
Muscle MEP | Do not require an averaging. Thus immediate feedback can be available | Require at least partially functional motor pathways |
Preserved sensitivity and sensitivity even after posterior myelotomy | Incompatible with prolonged curarization | |
Exceptional adverse effects have been described: tongue or lip laceration, mandibular fracture, cardiac arrhythmia, epileptic seizures, scalp burn and intraoperative awareness | ||
Often difficult to carry out on patients under the age of 6 yr because of incomplete maturation of motor pathways | ||
Pedicle screw testing | Rapid and easy technique | Sensitive to a large number of anesthetics |
Can be combined with new surgical instruments used during screw placement | Can be distorted by curarization | |
High sensitivity for medial pedicle breach | Less sensitive for thoracic pedicle screws than for lumbar pedicle screw | |
Useful in minimally invasive surgery where anatomical landmarks may be challenging to visualize | Optimal alarm criteria not firmly established | |
Does not directly assess for neurological injury, only provides information regarding pedicle integrity |
- Citation: Park JH, Hyun SJ. Intraoperative neurophysiological monitoring in spinal surgery. World J Clin Cases 2015; 3(9): 765-773
- URL: https://www.wjgnet.com/2307-8960/full/v3/i9/765.htm
- DOI: https://dx.doi.org/10.12998/wjcc.v3.i9.765