Criteria for Detection and Pathological Significance of Response Decrement during Spinal Cord Monitoring

1988 
The intervention criteria for spinal cord monitoring (i.e., the changes in various response parameters believed to represent a significant defect of conduction and therefore calling for corrective action) have without exception been established empirically in the light of previous experience with the particular monitoring and surgical techniques employed. Retrospective analysis of a sufficient number of cases will eventually yield quantitative information concerning the incidence and severity of neurological impairment associated with a given degree and duration of response decrement, but there is general agreement that more “scientifically” based criteria are desirable. In this respect there are at least 4 questions to be answered: 1) what degree of response decrement constitutes a definite change? 2) what is the clinical significance of a given decrement? 3) over what period is the decrement likely to be fully or partially reversible? 4) how effectively can detection followed by reversal (or even attempted reversal) of a decrement reduce the likelihood and severity of clinical impairment? This paper will attempt to answer question 1) in the context of epidural spinal SEP monitoring of neurologically normal scoliosis patients, will argue that 2) and 3) are essentially unanswerable in a human context but may be approached by animal experiments, and that 4) can only be addressed in humans by retrospective examination of previous cases.
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