Yamamoto N, Takano H, Kitagawa H, Kawaguchi Y, Tsuji H, Uozaki Y
Department of Orthopaedic Surgery, Faculty of Medicine, Toyama Medical and Pharmaceutical University, Japan.
J Vasc Surg. 1994 Nov;20(5):826-33. doi: 10.1016/s0741-5214(94)70171-7.
This clinical study was to evaluate changes of evoked spinal cord potentials (ESCPs) elicited by direct spinal cord stimulation and to determine their relation to spinal cord ischemia during aortic aneurysm surgery.
We monitored descending ESCPs from the thoracic spinal cord and lumbar enlargement after cervical spinal cord stimulation (thoracic descending ESCP and lumbar descending ESCP), and segmental ESCP at lumbar enlargement elicited by bilateral tibial nerve stimulation in 22 aortic aneurysm surgical operations.
ESCP changes were classified into three types: (1) decrease of amplitude in lumbar descending ESCP and segmental ESCP; (2) decrease of amplitude in segmental ESCP alone; (3) decrease of amplitude in all ESCPs. The late negative waves of both lumbar descending ESCP and segmental ESCP were more sensitive than other components of ESCPs. Postoperative paraplegia occurred in the two cases that showed persistent diminution of amplitude in the late negative waves. Segmental ESCP was less reliable than lumbar descending ESCP, because it depended entirely on the adequate perfusion of the lower extremities.
Lumbar descending ESCP was the best method for the spinal cord ischemia during aortic aneurysm surgery. Spinal cord ischemia could be detected by diminution in the amplitude of the late negative wave of lumbar descending ESCP. The recovery amplitude of the late negative wave after declamping correlated with the neurologic outcome.
本临床研究旨在评估直接脊髓刺激诱发的脊髓诱发电位（ESCPs）的变化，并确定其与主动脉瘤手术期间脊髓缺血的关系。
在22例主动脉瘤手术中，我们监测了颈脊髓刺激后胸段脊髓和腰膨大的下行ESCPs（胸段下行ESCP和腰段下行ESCP），以及双侧胫神经刺激诱发的腰膨大节段性ESCP。
ESCP变化分为三种类型：（1）腰段下行ESCP和节段性ESCP波幅降低；（2）仅节段性ESCP波幅降低；（3）所有ESCP波幅降低。腰段下行ESCP和节段性ESCP的晚期负波比ESCP的其他成分更敏感。术后截瘫发生在两例晚期负波波幅持续降低的病例中。节段性ESCP不如腰段下行ESCP可靠，因为它完全依赖于下肢的充分灌注。
腰段下行ESCP是评估主动脉瘤手术期间脊髓缺血的最佳方法。脊髓缺血可通过腰段下行ESCP晚期负波波幅降低来检测。松开阻断后晚期负波的恢复波幅与神经功能预后相关。
