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Validity and utility of monopolar spinal cord stimulation in pediatric scoliosis surgery

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Abstract

Purpose

To assess the validity and utility of monopolar stimulation (between a peridural needle and a large adhesive anode placed in the sternal area) for intraoperative monitoring in scoliosis surgery.

Methods

This procedure was assessed during 41 operations involving either arthrodesis with posterior instrumentation or a Vertical Expandable Prosthetic Titanium Rib (VEPTR). Responses evoked by monopolar stimulation were compared with those evoked by bipolar stimulation between two epidural needle electrodes. Potentials evoked by monopolar stimulation in the upper limbs were compared with those evoked in the lower limbs during the same stimulation procedure.

Results

Monopolar stimulation yielded equivalent and, if anything, more stable responses in the lower limbs. Recording in the upper limbs was satisfactory and allowed a decrease in responses to be detected in two patients. Acceptable thresholds for changes in amplitude relative to baseline were 40 % for upper limbs and 30 % for lower limbs.

Conclusions

Monopolar stimulation can be used to monitor the spinal cord during surgery for scoliosis correction. This procedure is more convenient for the surgeon and allows for the combined recording of responses in all four limbs, which can be useful in the case of surgical techniques such as those involving a VEPTR.

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Acknowledgments

The authors would like to thank the electrophysiology technicians who helped to record the electrophysiological responses, and Elizabeth Wiles-Portier who revised the English style.

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Authors and Affiliations

  1. Department of Neurophysiology, Rennes University Hospital, 35033, Rennes, France

    Constantin Gomes, Mathieu Kuchenbuch & Paul Sauleau

  2. Department of Pediatric Orthopedic Surgery, Rennes University Hospital, 35033, Rennes, France

    Grégory Lucas & Philippe Violas

  3. “Behavior and Basal Ganglia” Research Unit (EA 4712), EA 4712 “Comportement et Noyaux Gris Centraux”, Faculté de Médecine, Université de Rennes 1, Avenue Léon Bernard, 35043, Rennes, France

    Soizic Argaud & Paul Sauleau

Authors
  1. Constantin Gomes
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  2. Mathieu Kuchenbuch
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  3. Grégory Lucas
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  4. Soizic Argaud
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  5. Philippe Violas
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  6. Paul Sauleau
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Corresponding author

Correspondence to Paul Sauleau.

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None of the authors have potential conflicts of interest to be disclosed regarding this study.

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No specific funding source for this study.

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Gomes, C., Kuchenbuch, M., Lucas, G. et al. Validity and utility of monopolar spinal cord stimulation in pediatric scoliosis surgery. Eur Spine J 25, 3201–3207 (2016). https://doi.org/10.1007/s00586-016-4504-6

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  • DOI: https://doi.org/10.1007/s00586-016-4504-6

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