• Russ Lyon, Jeremy A Lieberman, Mark T Grabovac, and Serena Hu.
• Department of Neurosurgery, University of California, San Francisco, CA 94143-0648, USA.
• J Neurosurg Anesthesiol. 2004 Apr 1;16(2):167-70.

AbstractSurgical correction of kyphoscoliosis may result in spinal cord injury and neurologic deficits. Monitoring somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (MEPs) intraoperatively may allow for early detection and reversal of spinal cord injury. Controlled hypotension and isovolemic hemodilution are often used during these cases to reduce blood loss and transfusion. However, these physiologic parameters may affect the quality of SSEP and MEP signals. Acute reduction or loss of MEP or SSEP signals during spinal distraction presents a crisis for the operative team: should distraction be immediately relieved? The authors describe three patients who showed a decrease in evoked potential signals under hypotensive, hemodiluted conditions at the stage of spinal distraction. Each case illustrates a different strategy for successful management of these patients.

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