Analysis and Management of Blood Pressure on Intraoperative Cortex Somatosensory Evoked Potential in the Surgery of Severe Scoliosis_West China Medical Journal

Authors：

 SUNLin , LUOChao ,  SONGYue-ming , LIULi-min , GONGQuan , ZENGJian-cheng

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

SONGYue-ming, Email: sym_cd@aliyun.com

Keywords：

Severe scoliosis; Somatosensory evoked potential; Blood pressure; Corrective surgery

DOI：

10.7507/1002-0179.20140006

Video：

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Objective To investigate the influence and management of blood pressure on intraoperative cortex somatosensory evoked potential (CSEP) in the surgery of severe scoliosis. Methods From June 2009 to March 2012, CSEP monitoring during surgery of severe scoliosis were performed on 43 patients, in whom 4 had abnormal CSEP while blood pressure decline. There were 2 males and 21 females. The average age was 16.1 years. The average preoperative Cobb angle was 96.1° (88.7-107.5°). Latency and amplitude of cortical potentials were observed with the value of the latency extension more than 10% and peak amplitude reduction more than 50% defined as abnormality. The arterial blood pressure (ABP) was used to evaluate the intraoperative blood pressure. Result The incidence rate of bilateral CSEP wave abnormalities after blood pressure decline was 9.3% in the surgery of severe scoliosis. One case of CSEP abnormality occurred during the installing of pedicle screws; two cases during the Smith-Petersen osteotomy, and one case during the bone graft after correction. With the ABP dropping to about 92/57 mm Hg (1 mm Hg=0.133 kPa), the amplitude decreased 80% in 24-33 minutes. After the ABP increased to 113/75 mm Hg by treatment, the index was backed up normally in 5-10 minutes. There was no neurological complication after surgery. Conclusion A high incidence rate and significantly decreased amplitude of CSEP abnormality after blood pressure decline in the surgery of severe scoliosis are found. Intraoperative stable blood pressure should be maintained for patients with severe scoliosis. When the amplitude of CSEP decreases followed with blood pressure decline, blood pressure should be actively corrected by treatment, so that the CSEP may get back to normal as soon as possible.

Citation： SUNLin, LUOChao, SONGYue-ming, LIULi-min, GONGQuan, ZENGJian-cheng. Analysis and Management of Blood Pressure on Intraoperative Cortex Somatosensory Evoked Potential in the Surgery of Severe Scoliosis. West China Medical Journal, 2014, 29(1): 19-22. doi: 10.7507/1002-0179.20140006 Copy

1.	Feng B, Qiu G, Shen J, et al. Impact of multimodal intraoperative monitoring during surgery for spine deformity and potential risk factors for neurological monitoring changes[J]. J Spinal Disord Tech, 2012, 25(4):108-114.
2.	周琪琪, 張小鋒. 神經監測技術在臨床手術中的應用[M]. 北京:中國社會出版社, 2005:24-26.
3.	Nuwer MR, Dawson EG, Carlson LG, et al. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery:results of a large multicenter survey[J]. Clin Neurophysiol, 1995, 96(1):6-11.
4.	Nash CL, Lorig RA, Schalzinger LA, et al. Spinal cord montoring during operative treatment of the spine[J]. Clin Orthop Relat Res, 1977(126):100-105.
5.	Fehlings MG, Brodke DS, Norvell DC, et al. The evidence for intraoperative neurophysiological monitoring in spine surgery:does it make a difference?[J]. Spine (Phila Pa 1976), 2010, 35(9 Suppl):s37-s46.
6.	Mendiratta A, Emerson RG. Neurophysiologic intraoperative monitoring of scoliosis surgery[J]. J Clin Neurophysiol, 2009, 26(2):62-69.
7.	Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity:analysis of a prospective series of one hundred two cases with Independent evaluation[J]. Spine (Phila Pa 1976), 2009, 34(14):1504-1512.
8.	楊軍林, 黃紫房, 鄧耀龍, 等. SSEP、MEP和DNEP在重度脊柱畸形截骨矯形術中同時聯合監測的意義[J]. 脊柱外科雜志, 2011, 9(6):323-326.
9.	曾巖, 馬越, 孫垂國, 等. 體感誘發電位監測在胸腰椎后凸矯形手術中的應用[J]. 中國脊柱脊髓雜志, 2009, 19(8):579-582.
10.	齊宗華, 西永明, 劉勇, 等. 頸胸椎手術中體感誘發電位監護的影響因素分析及準確性觀察[J]. 中華外科雜志, 2007, 45(4):240-242.
11.	Schwartz DM, Auerbach JD, Dormans JP, et al. Neurophysiological detection of impending spinal cord injury during scoliosis surgery[J]. J Bone Joint Surg Am, 2007, 89(11):2440-2449.
12.	姚維紅. 有創血壓和無創血壓測量值的比較[J]. 現代中西醫結合雜志, 2007, 16(31):4643.
13.	陳裕光, 萬勇, 鄭召民, 等. 脊柱側凸手術中TES-MEP、CSEP陽性與手術操作相關原因分析[J]. 脊柱外科雜志, 2010, 8(2):86-89.
14.	史亞民, 侯樹勛, 李利, 等. 脊柱畸形手術失敗原因與對策[J]. 中華骨科雜志, 2005, 25(12):705-711.
15.	Nuwer MR. Spinal cord monitoring[J]. Muscle Nerve, 1999, 22(12):1620-1630.
16.	白斌, 王坤正, 劉文科, 等. 兒童脊柱側凸手術中皮層體感誘發電位監護的臨床研究[J]. 中華小兒外科雜志, 2003, 24(5):427-429.
17.	Owen JH, Jenny AB, Naito M, et al. Effects of spinal cord lesioning on somatosensory and neurogenic-motor evoked potentials[J]. Spine (Phila Pa 1976), 1989, 14(7):673-682.
18.	Weinzierl MR, Reinacher P, Gilsbach JM, et al. Combined motor and somatosensory evoked potentials for intraoperative monitoring:intra- and postoperative data in a series of 69 operations[J]. Neurosurg Rev, 2007, 30(2):109-116.

1. Feng B, Qiu G, Shen J, et al. Impact of multimodal intraoperative monitoring during surgery for spine deformity and potential risk factors for neurological monitoring changes[J]. J Spinal Disord Tech, 2012, 25(4):108-114.
2. 周琪琪, 張小鋒. 神經監測技術在臨床手術中的應用[M]. 北京:中國社會出版社, 2005:24-26.
3. Nuwer MR, Dawson EG, Carlson LG, et al. Somatosensory evoked potential spinal cord monitoring reduces neurologic deficits after scoliosis surgery:results of a large multicenter survey[J]. Clin Neurophysiol, 1995, 96(1):6-11.
4. Nash CL, Lorig RA, Schalzinger LA, et al. Spinal cord montoring during operative treatment of the spine[J]. Clin Orthop Relat Res, 1977(126):100-105.
5. Fehlings MG, Brodke DS, Norvell DC, et al. The evidence for intraoperative neurophysiological monitoring in spine surgery:does it make a difference?[J]. Spine (Phila Pa 1976), 2010, 35(9 Suppl):s37-s46.
6. Mendiratta A, Emerson RG. Neurophysiologic intraoperative monitoring of scoliosis surgery[J]. J Clin Neurophysiol, 2009, 26(2):62-69.
7. Quraishi NA, Lewis SJ, Kelleher MO, et al. Intraoperative multimodality monitoring in adult spinal deformity:analysis of a prospective series of one hundred two cases with Independent evaluation[J]. Spine (Phila Pa 1976), 2009, 34(14):1504-1512.
8. 楊軍林, 黃紫房, 鄧耀龍, 等. SSEP、MEP和DNEP在重度脊柱畸形截骨矯形術中同時聯合監測的意義[J]. 脊柱外科雜志, 2011, 9(6):323-326.
9. 曾巖, 馬越, 孫垂國, 等. 體感誘發電位監測在胸腰椎后凸矯形手術中的應用[J]. 中國脊柱脊髓雜志, 2009, 19(8):579-582.
10. 齊宗華, 西永明, 劉勇, 等. 頸胸椎手術中體感誘發電位監護的影響因素分析及準確性觀察[J]. 中華外科雜志, 2007, 45(4):240-242.
11. Schwartz DM, Auerbach JD, Dormans JP, et al. Neurophysiological detection of impending spinal cord injury during scoliosis surgery[J]. J Bone Joint Surg Am, 2007, 89(11):2440-2449.
12. 姚維紅. 有創血壓和無創血壓測量值的比較[J]. 現代中西醫結合雜志, 2007, 16(31):4643.
13. 陳裕光, 萬勇, 鄭召民, 等. 脊柱側凸手術中TES-MEP、CSEP陽性與手術操作相關原因分析[J]. 脊柱外科雜志, 2010, 8(2):86-89.
14. 史亞民, 侯樹勛, 李利, 等. 脊柱畸形手術失敗原因與對策[J]. 中華骨科雜志, 2005, 25(12):705-711.
15. Nuwer MR. Spinal cord monitoring[J]. Muscle Nerve, 1999, 22(12):1620-1630.
16. 白斌, 王坤正, 劉文科, 等. 兒童脊柱側凸手術中皮層體感誘發電位監護的臨床研究[J]. 中華小兒外科雜志, 2003, 24(5):427-429.
17. Owen JH, Jenny AB, Naito M, et al. Effects of spinal cord lesioning on somatosensory and neurogenic-motor evoked potentials[J]. Spine (Phila Pa 1976), 1989, 14(7):673-682.
18. Weinzierl MR, Reinacher P, Gilsbach JM, et al. Combined motor and somatosensory evoked potentials for intraoperative monitoring:intra- and postoperative data in a series of 69 operations[J]. Neurosurg Rev, 2007, 30(2):109-116.

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West China Medical Journal

Analysis and Management of Blood Pressure on Intraoperative Cortex Somatosensory Evoked Potential in the Surgery of Severe Scoliosis

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