Phillips L H, Blanco J S, Sussman M D
Department of Neurology, University of Virginia Health Sciences Center, Charlottesville.
Muscle Nerve. 1995 Mar;18(3):319-25. doi: 10.1002/mus.880180309.
Intraoperative electrophysiological monitoring of the spinal cord has traditionally been done by recording somatosensory evoked potentials (SEP). There is a risk that SEPs can be unaltered when significant injury to the anterior spinal cord has occurred. The purpose of this report is to describe a simple technique for intraoperative spinal cord stimulation which monitors descending pathways in the anterior spinal cord. Stimulation occurs through needle electrodes inserted into spinous processes in the rostral surgical wound, and recordings are made from electrodes in the popliteal spaces. We report our experience in monitoring spinal instrumentation in 45 patients with idiopathic scoliosis and 20 with some form of neurological disease causing scoliosis. The neurogenic motor evoked potentials (NMEP) are stable and easily recorded from the popliteal spaces in the majority of patients. We describe the case of 1 patient with Friedreich's ataxia in whom no SEPs could be recorded, but NMEPs were used successfully for monitoring. We have fond that combining traditional SEP monitoring with NMEP recording provides a safe and effective method to monitor the spinal cord during surgical procedures where it is at risk.
脊髓术中电生理监测传统上是通过记录体感诱发电位（SEP）来进行的。当脊髓前部发生严重损伤时，存在SEP可能未发生改变的风险。本报告的目的是描述一种用于术中脊髓刺激的简单技术，该技术可监测脊髓前部的下行通路。刺激通过插入手术伤口头侧棘突的针电极进行，记录则来自腘窝间隙的电极。我们报告了在45例特发性脊柱侧凸患者和20例因某种形式的神经疾病导致脊柱侧凸患者中监测脊柱器械植入的经验。在大多数患者中，神经源性运动诱发电位（NMEP）稳定且易于从腘窝间隙记录。我们描述了1例弗里德赖希共济失调患者的病例，该患者无法记录到SEP，但NMEP成功用于监测。我们发现，将传统的SEP监测与NMEP记录相结合，为在脊髓有风险的手术过程中监测脊髓提供了一种安全有效的方法。
