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, 张小锋. 神经监测技术在临床手术中的应用[M]. 北京:中国社会出版社, 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.	杨军林, 黄紫房, 邓耀龙, 等. SSEP、MEP和DNEP在重度脊柱畸形截骨矫形术中同时联合监测的意义[J]. 脊柱外科杂志, 2011, 9(6):323-326.
9.	曾岩, 马越, 孙垂国, 等. 体感诱发电位监测在胸腰椎后凸矫形手术中的应用[J]. 中国脊柱脊髓杂志, 2009, 19(8):579-582.
10.	齐宗华, 西永明, 刘勇, 等. 颈胸椎手术中体感诱发电位监护的影响因素分析及准确性观察[J]. 中华外科杂志, 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.	姚维红. 有创血压和无创血压测量值的比较[J]. 现代中西医结合杂志, 2007, 16(31):4643.
13.	陈裕光, 万勇, 郑召民, 等. 脊柱侧凸手术中TES-MEP、CSEP阳性与手术操作相关原因分析[J]. 脊柱外科杂志, 2010, 8(2):86-89.
14.	史亚民, 侯树勋, 李利, 等. 脊柱畸形手术失败原因与对策[J]. 中华骨科杂志, 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, 刘文科, 等. 儿童脊柱侧凸手术中皮层体感诱发电位监护的临床研究[J]. 中华小儿外科杂志, 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, 张小锋. 神经监测技术在临床手术中的应用[M]. 北京:中国社会出版社, 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. 杨军林, 黄紫房, 邓耀龙, 等. SSEP、MEP和DNEP在重度脊柱畸形截骨矫形术中同时联合监测的意义[J]. 脊柱外科杂志, 2011, 9(6):323-326.
9. 曾岩, 马越, 孙垂国, 等. 体感诱发电位监测在胸腰椎后凸矫形手术中的应用[J]. 中国脊柱脊髓杂志, 2009, 19(8):579-582.
10. 齐宗华, 西永明, 刘勇, 等. 颈胸椎手术中体感诱发电位监护的影响因素分析及准确性观察[J]. 中华外科杂志, 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. 姚维红. 有创血压和无创血压测量值的比较[J]. 现代中西医结合杂志, 2007, 16(31):4643.
13. 陈裕光, 万勇, 郑召民, 等. 脊柱侧凸手术中TES-MEP、CSEP阳性与手术操作相关原因分析[J]. 脊柱外科杂志, 2010, 8(2):86-89.
14. 史亚民, 侯树勋, 李利, 等. 脊柱畸形手术失败原因与对策[J]. 中华骨科杂志, 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, 刘文科, 等. 儿童脊柱侧凸手术中皮层体感诱发电位监护的临床研究[J]. 中华小儿外科杂志, 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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Analysis and Management of Blood Pressure on Intraoperative Cortex Somatosensory Evoked Potential in the Surgery of Severe Scoliosis

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