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Subpial spinal evoked potentials in patients undergoing junctional dorsal rootentry zone coagulation for pain relief
Prestor, Borut ; Žgur, Tomaž ; Dolenc, Vinko V.
Seven patients with complete avulsion of the brachial plexus underwent junctional coagulation lesions of the dorsal root entry zone (DREZ) for reliefof intractable pain in the paralyzed arm. ...Intra-operative monitoring by recording spinal cord somatosensory evoked potentials (SEP) resulting from tibial nerve stimulation was done using subpial recording electrodes situated dorsal to the posterior median sulcus at the C4 and T2 segment. SEP on the normal side showed an initial positive wave and two negative waves followed bya group of high frequency waves of relatively high amplitude which continuedinto high frequency, low amplitude potentials. The conduction velocity of the fastest spinal evoked potential components were, on average, 86 m/s. Recordings from the side of avulsion revealed a steep positive potential of high amplitude which appeared in five patients prior to the creation of the DREZ lesion. This effect was assumed to be secondary to spinalcord damage caused by avulsion. During the DREZ coagulation the SEP fromthe unaffected side did not change. On the side of DREZ coagulation the velocity of the fastest fibres decreased. Four patients reported sensory deficits after the operation, which were transient in three. In one of these patients, the first two negative potentials disappeared. In the fourth patient, who had permanent sensory deficits, the positive steep potential appeared after generation of the lesion. Our results point to the usefulness of the subpial SEPs monitoring during microneuro-surgical procedures on the spinal cord to provide further insight into evoked electrical activity of the normal and injured spinal cord, and to minimize post-operative neurological morbidity.
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