Article

Prospective, observational study. OBJECTIVES: To assess the spinal
cord function intraoperatively in subjects during spine stabilization for spinal
cord trauma, by recording muscular (m-MEPs) and epidural motor evoked potentials
(e-MEPs, D wave) along with cortical and epidural somatosensory evoked potentials
(e-SEPs) and predicting the outcome of spinal cord injury (SCI). SETTING:
Regional Trauma Center, Torino, Italy. METHODS: Fifty-five patients were
intraoperatively studied during posterior spine stabilization surgery for
traumatic SCI. In all, 21 of these had complete SCI, 14 an incomplete SCI-6 of
them with central cord syndrome and 1 with central cord plus Brown Sequard
syndrome-and 20 patients were neurologically uncompromised. RESULTS: The
neurophysiologic profile of the complete SCI was the absence of both m-MEPs and
e-MEPs caudally to the lesion site, associated with a lack of cortical and e-SEPs
cranially to the lesion site. None of these patients recovered motor function in
the follow-up. A clearly detectable caudal D wave was associated with motor
recovery even in deeply paraparetic patients. In one neurologically incomplete
patient a reversible deterioration of m-MEPs and e-MEPs was observed during the
compression-distraction manoeuvre. CONCLUSION: Intraoperative neurophysiological
evaluation of SCI patients can provide information about spinal cord function
that is not retrievable by other clinical means and can correctly predict
neurological outcome. Intraoperative testing during early stabilization of the
spine of deeply paraparetic SCI patients provides additional information about
their neurological profile.

Langue : ANGLAIS