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Controversies in clinical neurophysiology
Electroencephalography and clinical Neurophysiology, 1989, 73:373
373
Elsevier ScientificPublishers Ireland, Ltd.
Controversies in Clinical Neurophysiology Editorial Comment The controversy on 'intraoperative monitoring by evoked potentials for spinal cord surgery' is discussed by two prominent clinical neurophysiologists. Jasper R. Daube presents arguments in favor of intraoperative monitoring to reduce neuronal damage. In 351 cases of monitoring at the Mayo Clinic he estimates a benefit in 1% of the patients at the total cost of less than U.S. $200,000 ($569/patient). Michael J. Aminoff on the other hand, raises the question of the validity of monitoting the function of the dorsal column to prevent motor deficits. He also raises the problem of false negative and false positive results. The definition of false positive and negative results is also an area of disagreement. The question of cost-benefit ratio in the monitoring of spinal cord surgery
transcends the narrow realm of medical science but involves socio-ethical and economic issues that may ultimately be decided by local government legislation. Obviously the safety of the patient undergoing spinal cord surgery is everybody's concern, the role of intraoperative monitoring therefore needs to be defined. The available data on the various monitoring techniques for spinal cord surgery do not allow a consensus, the issue will remain controversial for some time. To quote Sir Winston Churchill (1942): ' N o w this is not the end. It is not even the beginning. But it is, perhaps, the end of the beginning.'
0013-4649/89/$03.50 © 1989 ElsevierScientificPublishers Ireland, Ltd.
Gastone G. Celesia Editor-in-Chief
373
Elsevier ScientificPublishers Ireland, Ltd.
Controversies in Clinical Neurophysiology Editorial Comment The controversy on 'intraoperative monitoring by evoked potentials for spinal cord surgery' is discussed by two prominent clinical neurophysiologists. Jasper R. Daube presents arguments in favor of intraoperative monitoring to reduce neuronal damage. In 351 cases of monitoring at the Mayo Clinic he estimates a benefit in 1% of the patients at the total cost of less than U.S. $200,000 ($569/patient). Michael J. Aminoff on the other hand, raises the question of the validity of monitoting the function of the dorsal column to prevent motor deficits. He also raises the problem of false negative and false positive results. The definition of false positive and negative results is also an area of disagreement. The question of cost-benefit ratio in the monitoring of spinal cord surgery
transcends the narrow realm of medical science but involves socio-ethical and economic issues that may ultimately be decided by local government legislation. Obviously the safety of the patient undergoing spinal cord surgery is everybody's concern, the role of intraoperative monitoring therefore needs to be defined. The available data on the various monitoring techniques for spinal cord surgery do not allow a consensus, the issue will remain controversial for some time. To quote Sir Winston Churchill (1942): ' N o w this is not the end. It is not even the beginning. But it is, perhaps, the end of the beginning.'
0013-4649/89/$03.50 © 1989 ElsevierScientificPublishers Ireland, Ltd.
Gastone G. Celesia Editor-in-Chief