Monitorage non invasif et sélectif des cordons postérieurs et de la voie pyramidale pendant les chirurgies du rachis et de la moelle épinière

For intra-operative neurophysiological monitoring during spine and spinal cord surgery, the challenge is to detect, in real-time, the occurrence of neurological impairment at onset in order to remedy the problem as quickly as possible before it becomes definitely acquired and irreversible. The past three decades were marked by considerable technical progress. Feasibility and reliability have now reached a very high level. A multimodal approach combining simultaneous monitoring of somatosensory and motor pathways has enabled a considerable decline in the rate of false negatives reported in the 80s when somatosensory evoked potentials (SSEP) were monitored alone. Several methods of monitoring are described in the literature. Combining transcranial electric stimulation of muscle motor evoked potentials (mMEP) and cortical SSEP allows non-invasive and selective monitoring of the posterior columns and pyramidal tract. One of the most widely used techniques internationally backed by a broad consensus within the International Society of Intra-operative Neurophysiology (ISIN), this technique remains exceptional in French-speaking countries. We expose here the methodological aspects for the readers of La Revue Neurologique.