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The prevention of spinal cord ischemia during surgery on the thoracic aorta utilizing the evoked spinal cord potential evoked spinal cord potential vs. somatosensory evoked potential for spinal ischemic change

, : The prevention of spinal cord ischemia during surgery on the thoracic aorta utilizing the evoked spinal cord potential evoked spinal cord potential vs. somatosensory evoked potential for spinal ischemic change. Journal of the Japanese Association for Thoracic Surgery 34(2): 172-179

The evoked spinal cord potential was used as a monitor of spinal cord ischemia during surgery on the thoracic aorta. At first, experiments were performed on 21 dogs. Following laminectomy and lt. thoracotomy, evoked spinal cord potential to the stimulation from bipolor electrodes in the midline dorsal subdural space at the level of near L1 were recorded from needle electrodes in the intervertebral disk at the level of Th4-5. After baseline measurements, the thoracic aorta was occluded in all dogs by aortic cross-clamping (AXC) distal to the origin of the left subclavian artery. Then four types of changes were detected. Type IA (n=3) showed transient augmentation of loss of the ESPs during AXC and return after reperfusion. Type-IB (n=6) showed loss of the ESPs during AXC without transient augmentation, and return after reperfusion. Type-II (n=11) showed no changes during and after AXC. Type-III (n=1) showed return of ESPs after transient loss even during AXC. Because the results looked different from that of SEP's, sciatic nerve evoked potentials (SCIEP) were recorded at the same time with ESPs during AXC on each of our ESP's types. All of them showed loss of SCIEPs during AXC and their return after reperfusion. Therefore, it seemed that SEP to the stimulation of the peripheral nerve doesn't always reflect the spinal cord function. Secondly, ESP was used as a monitor of spinal cord ischemia during operation on 9 patients. 6 pts. showed no changes of ESPs, but 3 showed loss of ESPs during AXC and return after reperfusion. No paraplegia appeared. We have concluded that intraoperative ESP monitoring is a more reliable indicator of spinal cord ischemia than other methods previously reported.

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