GUIDELINES: INTRA-OPERATIVE SPINAL CORD MONITORING

Intra-operative spinal cord monitoring (SCM) is utilised to allow early recognition of spinal cord insult and allow remedial action to maximise the chance of avoiding / minimising the clinical sequelae of spinal cord injury

Spinal cord monitoring encompasses many techniques from EMG (muscle activity), triggered EMG’s to more sophisticated “D” wave monitoring, somatosensory, motor-evoked techniques and combinations.  Monitoring involves a high level of understanding by the surgeon, anaesthetist and technician as successful monitoring requires anaesthetic changes and patient blood pressure control. Recognition of a problem - real and artifactual - needs understanding of the technique.  Due to costs involved, surgeon directed systems are available.  Preferably, suitably trained technicians should be present to provide continuous monitoring, especially when SSEP and multimodal monitoring is employed.  Even when a technician is present, the surgeon remains responsible for decision making based on their input along with those of the other theatre staff

The benefit is early recognition of injury, but as this seldom occurs, cost considerations mandate that its use is selective 

There is evidence that monitoring can be useful in all aspects of spine surgery but as the level of risk varies, it should only be considered in specific cases

There is literature to confirm that pedicle integrity can be assessed with triggered EMG

The role of SCM is in complex surgery when the cord is being manipulated either directly (tumour excision) or indirectly with deformity correction

Recommendation:

SCM be considered in spinal deformity correction and intra-thecal cord level surgery

If utilised, it is mandatory that the appropriate technique be utilised with adequately trained staff to interpret the changes

Reviewed 3 January 2013

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