Spinal Cord Monitoring in Neurosurgery in the United States

Summary

The clinical use of evoked potentials to monitor spinal cord problems in the neurosurgery community of the United States is becoming more and more common. Unfortunately, it is currently utilized in less than 1% of our cases. Its utilization as a diagnostic tool, during vascular manipulation of the spinal cord, in spinal corrective operations and during intrinsic cord procedures have all been reported. Not only have the sensory functions been assessed, but more recently techniques to stimulate the brain without causing seizure activity and record motor responses down the spinal cord have been developed. Once all these techniques become more standardized, not only in nomenclature but also in wave form, then their utilization will be more widely accepted. In those patients who have minimal neurologic deficit with maximum complaints, the diagnostic utility of evoked potentials is respected. In those patients who have devastating neurologic problems, the extent of the pathology can be measured. The frailty of the vascularity to the spinal cord and its influence on spinal cord conduction is now more than ever appreciated. Soon, it will be easier to do certain operative manipulations with reassurance that the spinal cord will not be irreparably damaged.