| Objective Many influencing factor can be seen during the intraoperative constant cortical somatosensory evoked potential (CSEP) monitoring anterior cervical spine surgery, include operation and non-operation factor. To determine contribution of non-operation factor such as changing posture and anesthesia of CSEP. Methods From January 2009 to February 2010 , 49 cases who underwent anterior cervical spine surgery were selected in our analyze. There were 29 males and 20 females, the mean age was 46.8 years (23～72years).20 cases of cervical spondylotic myelopathy , 15 cases of cervical prolapsed vertebral disc, 13 cases of cervical spine fracture and dislocations. All the patients must be done cervical vertebrae X-ray examination. in preoperative and calculation ratio of vertebral canal stenosis. The ratio of vertebral canal stenosis exceed 75% was group A; the ratio of vertebral canal stenosis less than 75% was group B. 49 cases were underwent Anterior Cervical Discectomy and Fusion (ACDF) surgery or anterior cervical spine sub-corpectomy and iliac bone graft internal fixation. Methods in own control study. All the patients had constant intraoperative CSEP monitoring performed. All patients were monitored by same doctor .Using the America Endeavor intraoperative monitor . Continuous stimulation on upper limb were performed to wrist media nerve and lower limb's posterior tibial nerve. Data of CSEP were obtained during consciousness,tracheal cannula,induction of anesthesia and patient preopositioning in all cases. Recode electrodes were Cz-FPz,C3,C4-FPz(according to the international 10-20 system ) ,when the patients went in to operating room, measurement CSEP of consciousness,anesthesia induction,tracheal cannula,change posture. Compare CSEP of every patient under consciousness situation to anesthesia induction and CSEP of anesthesia induction finish compare to tracheal cannula,changing posture .Reduction in primary somatosensory cortical amplitude in the cervical recorded lower than 50% or prolongation of response latency by greater than 10% were viewed as being significant Identify standard. Weather intravenous anesthesia propofol have effect to CSEP or not and how to develop effect. Weather the tracheal cannula and posture changing have effect to CSEP or not, and how to effect. The patient who monitored by CSEP under different ratio of vertebral canal stenosis in anesthesia induction,tracheal cannula,posture changing was same or not. Results 1. 1 case of cervical spondylotic myelopathy, wave of CSEP no matter when the patient consciousness or anesthesia induction were split and difficult to be monitored.2.The drugs which function is induction of anesthesia can decrease the amplitude and prolongation latency of CSEP. Left upper extremity amplitude decrease (8.99±7.58)%, prolongation latency in (1.60±1.52)%. Right upper extremity amplitude decrease(18.29±15.31)%, prolongation latency in(3.41±3.08)%. Left lower extremity amplitude decrease (11.21±9.07)%, prolongation latency (1.63±1.52)%. Right lower extremity amplitude decrease (15.07±14.27)%, prolongation latency(1.31±1.22)%. compare to conscious of CSEP have statistics significance.3. Compare the tracheal cannula, the CSEP with anesthesia induction show that the amplitude can increase or decrease, prolongation latency. Left upper extremity amplitude increase(6.14±6.09)%, prolongation latency (0.86±0.74)%. Right upper extremity amplitude decrease (10.08±9.83)%, prolongation latency (0.86±0.72)%. Left lower extremity amplitude decrease (3.60±3.29)%, prolongation latency (1.12±0.98)%. Right lower extremity amplitude decrease (2.82±2.61)%, prolongation latency (0.94±0.81)%.compare to anesthesia induction no statistics significance.4. During the posture changing , compare the amplitude and latency of CSEP with anesthesia induction have different change, Left upper extremity amplitude decrease (29.32±27.18)%, prolongation latency (5.49±5.14)%. Right upper extremity amplitude decrease (20.19±18.94)%, prolongation latency (3.62±3.54)%. Left lower extremity amplitude decrease (19.48±17.32)%, prolongation latency (1.74±1.31)%. Right lower extremity amplitude decrease (27.31±26.92)%, prolongation latency (4.69±4.34)%. compare to anesthesia induction of CSEP have statistics significance.5. Accompany the ratio of vertebral canal stenosis different , the changed of CSEP will also different. During tracheal cannula and anesthesia induction, the amplitude and latency of CSEP in group A and B group no tstatistics significance. During the posture changing, the amplitude and latency of CSEP have tstatistics significance in A group and B group. Conclusions In this study, propofol can decrease the amplitude and prolongation latency of CSEP. But cannot be defined a significant CSEP change. During the tracheal cannula, CSEP amplitude reduction and prolongation latency, also cannot be defined a significant CSEP change and no tstatistics significance .During the posture changing ,the amplitude and latency of CSEP compare to tracheal cannula have tstatistics significance. During tracheal cannula and anesthesia induction course , if accompany the ratio of spinal stenosis different ,the CSEP have no significant change. Nevertheless During the posture changing, the ratio of spinal stenosis different,the CSEP have significant change.
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