Table Of ContentK.Shimoji T.Kurokawa T.Tamaki
WD.WillisJr. (Eds.) ________
Spinal Cord
Monitoring and
Electrodiagnosis
With 240 Figures and 70 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona
KOKI SHIMOJI, M.D., Professor and Chairman
Department of Anesthesiology, Niigata University School of Medicine
Asahi-Machi 1, Niigata 951, Japan
TAKAHIDE KUROKAWA, M.D., Professor and Director
Department of Orthopaedic Surgery, Faculty of Medicine
University of Tokyo, 7-3-1 Hongo, Bunkyo-ku
Tokyo 113, Japan
TETSUYA TAMAKI, M.D., Professor and Chairman
Department of Orthopaedics, Wakayama Medical College
Wakayama, Japan
WILLIAM D. WILLIS Jr., M.D., Ph.D., Director
Marine Biomedical Institute Ashbel Smith,
Department of Anatomy and Neurosciences
The University of Texas Medical Branch at Galveston
200 University Boulevard, Galveston, Texas 77550-2772, USA
ISBN -13: 978-3-642-75746-4 e-ISBN -13 :978-3-642-75744-0
DOl: 10.1007/978-3-642-75744-0
Library of Congress Cataloging-in-Publication Data. Spinal cord monitoring and electrodiagnosis/
K. Shimoji ... ret al.] (eds.). p. cm. Based on the papers presented at the Fourth International
Symposium on Spinal Cord Monitoring and Electrodiagnosis held in Niigata, Japan, June 26-29,1989.
Includes bibliographical references. Includes index. ISBN-13:978-3-642-75746-4
1. Evoked potentials (Electrophysiology - Congresses. 2. Spinal cord -
Diseases - Diagnosis - Congresses. 3. Electrodiagnosis - Congresses. 4. Patient monitoring -
Congresses. I. Shimoji, Koki, 1935- . II. International Symposium on Spinal Cord Monitoring and
Electrodiagnosis (4th: 1989: Niigata-shi, Japan) [DNLM: 1. Electrodiagnosis-congresses. 2. Evoked
Potentials - congresses. 3. Monitoring, Physiology - congresses. 4. Spinal Cord - physiopathology
congresses. WL 400 S75778 1989] RC402.2.E94S67 1990 616.07'547 - dc20 DNLMIDLC 90-10106
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Preface
The spinal cord has a characteristic structure and functions that are distinct
from those of the brain. Its functions are tremendously important since it
modulates the peripheral sensory inputs to the dorsal horn, and it gives rise to
the ascending pathways transmitting peripheral afferent inputs to the brain,
and conveys the descending pathways from the brain both to the lower motor
neurons, the final common pathway, and to dorsal horn sensory neurons. In
spite of these vital functions, the spinal cord constitutes only a small percent
age of the mass of the human central nervous system and is located far
from the skin surface, which has obstructed the recording of its electrical
activity. Recently, however, important advances have been made in several
recording techniques, including epidural recording or averaging methods,
allowing both sensory and motor evoked spinal cord potentials in man to be
recorded.
This volume is based on the papers presented at the Fourth International
Symposium on Spinal Cord Monitoring and Electrodiagnosis. Each of these
international symposia has brought together many of the specialists involved
in this research, with an important increase in the number of participants
since the first symposium was held in Toyko in 1981. At the past symposia
several attempts were made to standardize data, techniques, and clinical
applications and to integrate the new findings into patient care.
The purpose of publication of this book is to provide an overview of
recent advances in the field of spinal cord monitoring and electrodiagnosis,
including data from basic physiological and pharmacological studies. It should
thus serve as a forum for the prevention of spinal cord damage during
operations and for the electrodiagnosis of spinal cord diseases.
We would like to thank Mitsuru Ebe, from the Japan Society of EEG and
EMG, for his welcoming comments at the symposium.
Niigata, K. SHIMOJI
Tokyo, T. KUROKAWA
Wakayama, T. TAMAKI
Galveston, W.D. WILLIS Jr.
Contents
I. Basic Considerations
A. Animal Studies
1. Neurophysiology of Spinal Cord
The Spinothalamic Tract and Other Ascending Nociceptive Pathways
of the Spinal Cord
W.O. WILLIS Jr.
With 2 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Motor and Sensory Tract Activation
Following Epidural Electrical Stimulation
E. TRANSFELDT, G. NIZNIK, F. SHICHIJO, T. OHSHIMA,
and B. POMERANZ
With 2 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Effects of Electric Current Application
on the Evoked Spinal Cord Potentials in Dogs
T. KANO and A. HAS HIGUCHI
With 4 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 13
The Significance of Motor Evoked Spinal Cord Potentials
Recorded from the Ventral Root in Cats
H. KAWAMURA, K. YOKOGUSHI, G. KATAHIRA, and M. MATSUMOTO
With 4 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 20
Monitoring Motor Function of the Spinal Cord:
The Descending Segmental Evoked Spinal Cord Potential
M. YOKOYAMA, K. SHINOMIYA, H. SATO, H. KOMORI, and K. FURUYA
With 8 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 27
VIII Contents
Experimental Study of the Origin of Transcranially Evoked
Descending Spinal Cord Potentials
To YAMAMOTO, Yo KATAYAMA, To TSUBOKAWA, So MAEJIMA,
To HIRAYAMA, and Jo XING
With 4 Figures 36
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
The Use of the Dog as a Model for Spinal Cord Monitoring Research
So UCHIYAMA, R.Ho BROWN, and CoL. NASH
With 3 Figures and 1 Table 43
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2. Neuropharmacology of Spinal Cord
Neurotransmitter Receptors and Voltage-Operated Channels
Expressed by Rat Spinal Cord mRNA in Xenopus Oocytes
Ho AKAGI and Ro MILEDI
With 2 Figures and 2 Tables 50
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Prototypical Features of the Inhibitory Synapses
in the Frog Spinal Cord as Revealed Pharmacologically
Yo KUDO and Eo AKIYOSHI
With 4 Figures 58
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Metabolic Depression of the Spinal Cord and Brain
with Epidural Bupivacaine in Rats
Yo KURODA, To SAKABE, Ko NAKAKIMURA, To MAEKAWA, To ISHIKAWA,
and Ho TAKESHITA
With 2 Tables 65
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
The Effects of Sevoflurane on Heterosegmental Slow Positive
Cord Potentials in the Rat
Mo TOHYAMA, So DENDA, Yo SATO, No FUJIWARA, and K. SHIMOJI
With 2 Figures and 1 Table 70
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
The Effects of Anesthetics on the Ventral Root Potential
in Spinal Cats
Mo MATSUMOTO, Ho KAWAMURA, and Ao NAMIKI
With 6 Figures 78
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
The Effects of Anesthetics on Spinal Cord Nociceptive Neural Activities
Ko SHINGU, Mo OSAWA, and Ko MORI
With 1 Table 85
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Contents IX
Monitoring the Expression of the C-fos Proto-Oncogene
to Study the Spinal Circuits that Contribute to Pain and its Control
A.!. BASBAUM, R. PRESLEY, S.-I. Cm, K.R. GOGAS, and J.D. LEVINE
With 3 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 92
3. Pathophysiology of Spinal Cord
Electrophysiological Differentiation Between Muscle
and Sensory Nerve Funiculi for Peripheral Nerve Repair
N. NAKATA, H. MATSUDA, A. MIYAucm, M. SEKI, and A. SIiIMAZU
With 6 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 101
Experimental Studies on the Spinal Cord Evoked Potentials
in Cervical Spine Distraction Injuries
N. KAWAHARA, H. BABA, S. NAGATA, Y. KIKUCHI, K. TOMITA,
S. NOMURA, and H. YUGAMI
With 8 Figures and 1 Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 107
Experimental Studies on the Spinal Cord Evoked Potentials
in Compression Injury of the Cervical Spinal Cord
S. NAGATA, H. BABA, U. KAWAHARA, Y. KIKUCHI, K. TOMITA,
S. NOMURA, and H. YUGAMI
With 5 Figures and 1 Table .............. . . . . . . . . . . . . . . . . . . . . . . . .. 116
Comparison Between Spinal Cord Evoked Potential
and Cortical Evoked Potential by Experimental Dorsal Compression
on the Thoracic Spinal Cord
S. SATO, S. UCHIYAMA, and K. TAKAHASHI
With 4 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 129
Spinal Cord Functions with Spinal Evoked Potentials
and Spinal Blood Flow by Retracting the Spinal Cord
H. KUCIDWAKI, S. INAO, K. ANDOH, H. IsmGuRI, and K. SUGITA
With 1 Figure and 2 Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 134
New and Sensitive Methods for Detecting Acute Axonal Dysfunction
After Experimental Spinal Cord and Root Compression Injury
K. SAKATANI, Y. HATABu, W. YOUNG, J.A. GRUNER, H. IIZUKA,
and K. TANIGUCm
With 5 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 141
x Contents
Physiological and Pharmacological Aspects
of the Modulation of Nociceptive Transmission
at the Dorsal Horn Level of the Spinal Cord
J.-M. BESSON
With 1 Figure .................................................. 152
B. Human Studies
1. Electrical Stimulations
Etomidate Augmentation of Scalp Recorded Somatosensory Waves:
Time Course, Reproducibility, and Dose Effect
R.W. MCPHERSON and R.C. LEVITT
With 4 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 163
Four Components and Their Origins of the Ascending Spinal
Potential Evoked by Stimulation at the Conus Medullaris Level
S. HIRABAYASHI, L. KENKOW, and T. KUROKAWA
With 3 Figures ............. ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 171
Somatotopical Evoked Responses from the Spinal Cord and
Cerebral Cortex to Finger Stimulation
H. TAKAHASHI, 1. SUZUKI, and B. ISHIJIMA
With 6 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 177
Spinal Evoked Potentials After Stimulation of Ventral Roots:
Do Ventral Root Afferents Exist in Man?
V. DELETlS, R. ABBOTT, and W. YOUNG
With 4 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 186
Spinal Evoked Potentials and Spine-Scalp Propagation Velocities:
Origins, Conduction Characteristics, and Clinical Observations
R.O. CRACCO, J.B. CRACCO, and L. PELOSI
With 4 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 193
Evoked Potential Patterns in Chronic Spinal Cord Lesions
M. SARZYNSKA, 1. HAFTEK, and J. HAFTEK
With 9 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 202
Contents XI
Observation of the Circulation of Cauda Equina
in Spinal Canal Stenosis Following Electrical Stimulation
of Peripheral Nerves
A. DEZAWA, S. MORIYA, H. KITAHARA, K. TAKAHASHI,
and M. MURAKAMI
With 6 Figures .................................................. 214
Short Latency Somatosensory Evoked Potentials
to Stimulation of Different Lower Extremity Nerves:
Nature of Generator Sources as Inferred from Scalp Topography
L. PELOSI, J.B. CRACCO, R.O. CRACCO, and N.F. HASSAN
With 3 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 220
Reflexes Evoked in Various Human Muscles
During Voluntary Activity
T. TANI, K. KIDA, H. YAMAMOTO, andJ. KIMURA
With 4 Figures and 1 Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 226
2. Magnetic Stimulations
Peripheral Electrophysiological Correlates
to Magnetic Transcranial Stimulation
J.R. TOLEIKIS and T.B. SLOAN
With 3 Figures and 2 Tables ...................................... 237
Motor Evoked Potentials Following
Transcranial Magnetic Stimulation in Cervical Myelopathy
Y. NISHUIMA, M. OKADA, T. IZUMI, N. TODA, and Y. YAMAZAKI
With 4 Figures and 3 Tables ...................................... 245
Magnetic Transcutaneous Stimulation
of the Motor Pathway in Spinal Cord Disorders
T. IIZUKA, H. AzuMA, H. TANAKA, H. SUGIOKA, and T. KONDO
With 3 Figures and 5 Tables ...................................... 253
Clinical Application of Motor Evoked Potentials
in Disorders of the Spine
J. DVORAK, J. HERDMANN, and R. THEILER
With 4 Figures and 1 Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 262
XII Contents
Motor Evoked Potentials: Issues in Safety and Operative Monitoring
W.J. LEVY, J. ORO, and M. TRAAD
With 5 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 273
II. Clinical Applications
A. Monitoring
Prognostication of Surgical Outcome in Cervical Spondylotic
Myelopathy Using Evoked Spinal Cord Potentials
K. SHINOMIYA, Y. KUROSA, M. FUCHIOKA, H. SATO, M. YOKOYAMA,
H. KOMORI, and K. FURUYA
With 4 Figures and 1 Table ....................................... 287
Intraoperative Spinal Cord Monitoring Using
Evoked Spinal Cord Potentials on Spinal Cord Tumors
Y. FUKUI, K. SATOMI, T. OKUMA, K. KENMOTSU, M. KAMATA, T. IKAI,
and K. HIRABAYASHI
With 6 Figures and 1 Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 296
Clinical Correlations of Intraoperative Evoked Potential
Monitoring in Spinal Cord Disorders
J.R. CASSIDY and T.B. DUCKER
With 4 Figures ............ , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 305
Intraoperative Evoked Potential Monitoring:
Fringe Benefits in the Operating Room
c.L.
R.H. BROWN, NASH Jr., J.T. STINSON, and F.A. BAUMAN
With 12 Figures ...................................... : . . . . . . . . .. 313
Ketamine as a Major Component of an Anesthetic Plan
for Spinal Cord Monitoring
W.T. FRAZIER, D.B. BIGGS, S.H. ODOM, and S.E. JENKINS
With 4 Figures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 325
Sensory and Motor Thresholds to Electrical Stimulation
of Ankles and Wrists During Spinal Cord Monitoring
W.T. FRAZIER, D.B. BIGGS, S.H. ODOM, and S.E. JENKINS
With 3 Figures and 1 Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 335
Somatosensory Evoked Potential Recordings
for Decision Making on Instrumentation During Scoliosis Surgery
Y. NODE and S. UEMATSU
With 2 Figures and 3 Tables ...................................... 346
