Perioperative neurologic injury related to spine surgery, albeit rare, can result in devastating functional loss. As the number of spine operations has increased, so has the need for strategies designed to avoid and protect against such injury. This chapter reviews the common etiologies of neurologic deficits secondary to spine surgery and the factors that place patients at increased risk for developing these complications. The use of intraoperative neuromonitoring, including somatosensory evoked potentials (SSEPs), electromyography (EMG), and transcranial motor evoked potentials (TcMEPs), to detect surgical trespass of neuronal elements is also reviewed. The authors also summarize the role of physiologic parameter optimization, including mean arterial blood pressure and body temperature, and pharmacologic interventions, should an injury occur. Current practice guidelines for preventing and managing perioperative neurologic injury are described.
Comparison of Propofol and Ketofol on Transcranial Motor Evoked Potentials in Patients Undergoing Thoracolumbar Spine Surgery
