Somatosensory evoked potential loss due to intraoperative pulse lavage during spine surgery: case report and review of signal change management

Arun George, Hironobu Hayashi, John Patrick F Bebawy, Antoun Koht*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Intraoperative neurophysiologic monitoring (IONM) includes various neurophysiologic tests which assess the functional integrity of the central and peripheral nervous systems during surgical procedures which place these structures at risk for iatrogenic injury. The rational for using IONM is to provide timely feedback of changes in neural function to enable the reversal of such insult before the development of irreversible neural injury. There are various causes of intraoperative loss of neuromonitoring signals and it is important to systematically rule out all possible causes quickly and thoroughly in order to target the cause of signal loss, correct it and take measures to prevent the same in the future. One such rare cause, is targeted and pressurized cold (room temperature) irrigation of the surgical site, which may induce irritation and vasospasm leading to ischemia of the affected portion of the spinal cord, hence leading to signal changes. We present this case to stress the importance of having knowledgeable members of the team who are well acquainted with all aspects of monitoring in close proximity to the operating room, so as to minimize troubleshooting time. Furthermore, we suggest the use of warm (body temperature) saline during irrigation to the surgical site, especially when using pressurized irrigation systems.

Original languageEnglish (US)
JournalJournal of Clinical Monitoring and Computing
DOIs
StatePublished - Jan 1 2019

Keywords

  • Intraoperative loss of neuromonitoring signal
  • Intraoperative neurophysiologic monitoring
  • Pulse lavage
  • Somatosensory evoked potentials
  • Spine surgery

ASJC Scopus subject areas

  • Health Informatics
  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

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