Efficacy of spinal cord monitoring in neuromuscular scoliosis.

Somatosensory cortical evoked potentials (SCEPs) monitoring in neuromuscular scoliosis surgery was evaluated in a large consecutive series of spinal reconstructions to define its role in the detection and prevention of spinal cord injury; 141 procedures in 101 patients were evaluated. In 28% a reliable tracing could not be obtained. Two postoperative neurologic deficits were missed by SCEP monitoring. Diagnosis (Duchenne muscular dystrophy and polio) was the only significant factor found to correlate with a reliable tracing. The use of sublaminar wires was associated with a higher rate of change in tracing. Transient changes were common. SCEPs are unreliable and nonspecific in neuromuscular scoliosis surgery and are not efficatious in preventing or detecting spinal cord injury when used alone. Adjunctive techniques using epidural and MEPs must be studied in these patients.