Spinal cord monitoring as a clinical utilization of the spinal evoked potential.

For the purpose of monitoring spinal cord function, evoked spinal cord potential was observed by recording electrodes in the subarachnoid space at the level of the conus medullaris and stimuli delivered to the rostral spinal cord from the epidural space. A specially designed, flexible tube-type electrode was used for both recording and stimulating. The spinal cord evoked potential consisted of an initial spike followed by polyphasic waves. The peak amplitude change was considered to be the main indicator of events that would potentially be hazardous to spinal cord function. Two hundred and twenty-nine operations were monitored by the recording electrode. Six of the patients experienced postoperative neurologic complications. During operation, the peak amplitudes of the evoked potentials diminished to less than 50% of the control values. Simultaneous monitoring of evoked potential revealed that this method was more sensitive than the wake-up test. No complications resulted from the application of this method. Thus, monitoring is a sufficiently sensitive, safe, and reliable method to be useful during aggressive surgery in the spine and spinal cord.