Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 58, Num. 6, 2010, pp. 980-980

Neurology India, Vol. 58, No. 6, November-December, 2010, pp. 980

Correspondence

Somatosensory evoked potentials monitoring in cervical spine surgery

George Fotakopoulos, George A Alexiou, Dimitrios Karagiorgiadis, Spyridon Voulgaris

Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
Correspondence Address: George A Alexiou, Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece, alexiougrg@yahoo.gr

Date of Acceptance: 07-Aug-2010

Code Number: ni10284

PMID: 21150087
DOI: 10.4103/0028-3886.73759

Sir,

We read the interesting recent article by Ayoub et al.^[1] concerning the usefulness and cost-effectiveness of somatosensory evoked potentials (SSEPs) during cervical spine surgery. The authors studied 210 consecutive patients who underwent surgery via anterior or posterior approach and found that SSEPs could help in preventing postoperative neurological deficit by the early detection of vascular or mechanical compromise and the consequent adaptation of the anesthetic or surgical technique. Furthermore, after performing a cost analysis, the authors found that SSEPs proved to be cost-effective. ^[1]

Intraoperative electrophysiological monitoring has increasingly been used to prevent neurological injury during spine surgery. With SSEPs, the reported rate of false-positive recordings is up to 28%, depending upon the location and number of channels and recording sites. ^[2] Of late, transcranial motor-evoked potentials (TcMEPs) have been used for intraoperative monitoring during spine surgery and found to be incurring equivalent or lower costs compared to SSEPs. TcMEPs require the placement of 3 electrodes, whereas SSEPs require 8 electrodes. Our earlier studies and unpublished data show TcMEPs and free-running electromyography to be an effective method for monitoring spinal cord during surgery for tumor excision, lumbar stenosis and cervical disk herniation. ^[3],[4] Furthermore, TcMEPs may predict postoperative improvement. An increase in the TcMEPs amplitude of more than 50% and 30% in patients with lumbar stenosis and cervical disk herniation, respectively, has been shown to predict greater postoperative improvement. Thus, we feel routine use of TcMEPs during spine surgery offers several advantages without changing the overall procedure-related cost.

References

1.	Ayoub C, Zreik T, Sawaya R, Domloj N, Sabbagh A, Skaf G. Significance and cost-effectiveness of somatosensory evoked potential monitoring in cervical spine surgery. Neurol India 2010;58:424-8.  Back to cited text no. 1  [PUBMED]
2.	Lubicky JP, Spadaro JA, Yuan HA, Fredrickson BE, Henderson N. Variability ofsomatosensory cortical evoked potential monitoring during spinal surgery. Spine (Phila Pa 1976) 1989;14:790-8.  Back to cited text no. 2
3.	Voulgaris S, Alexiou GA, Mihos E, Karagiorgiadis D, Zigouris A, Fotakopoulos G, et al. Posterior approach to ventrally located spinal meningiomas. Eur Spine J 2010;19:1195-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.	Voulgaris S, Karagiorgiadis D, Alexiou GA, Mihos E, Zigouris A, Fotakopoulos G, et al. Continuous intraoperative electromyographic and transcranial motor evoked potential recordings in spinal stenosis surgery. J Clin Neurosci 2010;17:274-6.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]

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