Preventing Paralysis During Spinal Surgery

Paraparesis, paraplegia, and quadriplegia are potential complications of spinal cord surgeries or procedures that put the spinal cord at risk. Intraoperative monitoring can alert surgeons and anesthesiologists when patients are at risk for these complications, allowing for prompt treatment to reduce patient harm when warnings are raised. Surgery can then be modified through various interventions, such as reducing the degree of distraction, adjusting retractors, removing or adjusting grafts or hardware, reimplanting or unclamping arteries, and placing vascular bypass grafts. Time to Take a Closer Look at Spinal Surgery In the February 21, 2012 issue of Neurology, my colleagues and I at the American Academy of Neurology and American Clinical Neurophysiology Society published an evidence-based guideline update on intraoperative spinal monitoring with somatosensory and motor evoked potentials. The guideline update was needed because the field of intraoperative spinal monitoring has been growing substantially, causing carriers to ask questions about its utility and ability to predict adverse surgical outcomes. Community hospitals are also beginning to look into intraoperative spinal monitoring as a service that they can provide. With changes in coding from the American Medical Association also occurring, it was a good time to answer these questions based on the current literature in evidence-based medicine. Intraoperative spinal monitoring involves monitoring sensory pathways by applying electrical pulses to the ankles or wrists. These pulses are carried up to the brain and recorded at the scalp. To reach the scalp, the pulses must travel up an intact spinal cord. The motor pathway is the exact opposite; electrical pulses are applied to the brain via the scalp. These pulses are recorded at the peripheral...