Document Detail


Electrophysiologic deterioration in surgery for thoracic disc herniation: impact of mean arterial pressures on surgical outcome.
MedLine Citation:
PMID:  24898311     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVE: Severe thoracic disc herniation leads to increased pressure in adjacent neural structures, which in turn can require an increase in mean arterial pressure (MAP) to maintain adequate spinal cord perfusion. We report a case series of three patients with severe thoracic disc herniation that experienced deteriorations in motor-evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) following induction of general anesthesia, but prior to decompression of the neural elements.
METHODS: In-depth chart reviews were completed for each patient from their initial presentation to long-term post-operative course. Careful attention was taken with regards to MAP at induction of each operative case.
RESULTS: The origin of the decreased signals in all patients was thought to relate to inadequate cord perfusion pressures. Two of the patients recovered pre-operative neurologic function while the third was left with mild post-operative paraparesis. Mean arterial pressures at time of deterioration were noted to be 58, 80, and 60 mmHg. These measurements represented MAPs approximately 65, 92, and 60 % those of baseline values, respectively.
CONCLUSION: Based on these experiences, the authors' institution has adopted new guidelines in the setting of thoracic disc herniations that includes pre-operative optimization of volume status, placement of an awake arterial line prior to induction of anesthesia, use of MEP and SSEP electrophysiologic monitoring, careful selection of anesthetic, and aggressive maintenance of MAPs >110 % of preoperative values at all times prior to decompression of the spinal cord.
Authors:
Scott L Zuckerman; Jonathan A Forbes; Akshitkumar M Mistry; Harish Krishnamoorthi; Sheena Weaver; Letha Mathews; Joseph S Cheng; Matthew J McGirt
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-6-5
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  -     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2014 Jun 
Date Detail:
Created Date:  2014-6-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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