The Value Of Applying Intraoparative Neurophysiological Monitoring During Spine And Spinal Based On The Theory Of Following The Prognosis Of A Disease

Objective:Spine and spinal cord surgery carries a signigicant risk of neurological impairment.Currently,the precaution is intraoperative neurophysiologic monitoring.To discuss the significance of the clinical application of motor evoked potential (MEP) and somatosensory evoked potentials (SEP) monitoring, and the instructional value of the theory of following the prognosis of a disease in the spinal surgery.Methods:From July 2009 to April 2010,12 patients were simultaneously recorded for the TES-MEP response on bilateral anterior tibial muscle,flexor hallucal brevis,thenar muscle,and SEP of median nerve and tibial nerve during the spinal surgery.The correlation of the latency and amplitude of the SEP and MEP with operation maneuvers and anaesthesia events were analyzed.Of the 12 patients,9 patients were anesthetized by total intravenous anesthesia,3 by propofol and a dose of muscle relaxation drugs,and 1 by combined intravenous and inhalation anesthesia.The warning criteria for SEP:â‘ a amplitude loss of at least 50%;â‘¡the latent period extended by at least 10%;the latent period extended more than 2.5ms;â‘¢both ofâ‘ andâ‘¡.The warning criteria for MEP:the latent period extended by at least 10% and/or a amplitude loss of at least 50% or a total amplitude loss.Results:In 12 cases,1 case showed improvement after operation; 1 case was failed to record TES-MEP;10 cases had no significant changes during operation. The depth of anesthesia could affect SEP recording,and muscle relaxant could affect MEP recording.The operation events and segmental blood vessel ligation correlated with SEP and MEP recording.Conclusions:Intraoperative combined SEP and MEP monitoring is a safe, reliable and sensitive method to detect and reduce intraoperative injury to the spinal cord, based on the theory of following the prognosis of a disease. Therefore, A combined use of SEP and MEP techniques would be advisable as routine practise during complex spine/spinal cord surgery.