Gomes Constantin, Kuchenbuch Mathieu, Lucas Grégory, Argaud Soizic, Violas Philippe, Sauleau Paul
Department of Neurophysiology, Rennes University Hospital, 35033, Rennes, France.
Department of Pediatric Orthopedic Surgery, Rennes University Hospital, 35033, Rennes, France.
Eur Spine J. 2016 Oct;25(10):3201-3207. doi: 10.1007/s00586-016-4504-6. Epub 2016 Mar 8.
To assess the validity and utility of monopolar stimulation (between a peridural needle and a large adhesive anode placed in the sternal area) for intraoperative monitoring in scoliosis surgery.
This procedure was assessed during 41 operations involving either arthrodesis with posterior instrumentation or a Vertical Expandable Prosthetic Titanium Rib (VEPTR). Responses evoked by monopolar stimulation were compared with those evoked by bipolar stimulation between two epidural needle electrodes. Potentials evoked by monopolar stimulation in the upper limbs were compared with those evoked in the lower limbs during the same stimulation procedure.
Monopolar stimulation yielded equivalent and, if anything, more stable responses in the lower limbs. Recording in the upper limbs was satisfactory and allowed a decrease in responses to be detected in two patients. Acceptable thresholds for changes in amplitude relative to baseline were 40 % for upper limbs and 30 % for lower limbs.
Monopolar stimulation can be used to monitor the spinal cord during surgery for scoliosis correction. This procedure is more convenient for the surgeon and allows for the combined recording of responses in all four limbs, which can be useful in the case of surgical techniques such as those involving a VEPTR.
评估单极刺激（在硬膜外针与置于胸骨区域的大型粘性阳极之间）用于脊柱侧弯手术术中监测的有效性和实用性。
在41例手术中评估了该程序，这些手术包括后路器械融合术或垂直可扩展人工钛肋骨（VEPTR）手术。将单极刺激诱发的反应与两个硬膜外针电极之间的双极刺激诱发的反应进行比较。在相同刺激程序中，比较单极刺激在上肢诱发的电位与在下肢诱发的电位。
单极刺激在下肢产生了等效且更稳定的反应。上肢记录效果良好，并且在两名患者中检测到反应降低。相对于基线，上肢振幅变化的可接受阈值为40%，下肢为30%。
单极刺激可用于脊柱侧弯矫正手术期间的脊髓监测。该程序对外科医生来说更方便，并且允许对四肢的反应进行联合记录，这在涉及VEPTR等手术技术的情况下可能有用。
