During intraoperative neuromonitoring, what does no change in the peripheral responses indicate with significant changes in cervical and cortical SSEPs?

The scenario presented involves significant changes in cervical and cortical somatosensory evoked potentials (SSEPs) while observing no change in the peripheral responses. When there is no alteration in the peripheral responses, it suggests that the peripheral nerve pathways are intact and functioning adequately, particularly in the context of median nerve stimulation.

An adequate median nerve stimulation suggests a successful activation of the sensory pathways that leads to responses in the central nervous system, specifically the cervical spine and the cortex. If the peripheral response remains consistent while other responses change, it indicates that the signal from the peripheral nerve is being effectively transmitted without degradation at the peripheral level.

This is particularly critical during surgeries where neurophysiological responses are monitored to ensure the integrity of neural pathways. The lack of change in the peripheral responses implies that the stimulation applied was sufficient to elicit the expected sensory pathways, allowing for better interpretation of the significant changes observed in the central SSEPs.

In contrast, if there were signs of changes in peripheral responses, this might indicate potential issues such as nerve damage or inadequate stimulation, which could lead to misinterpretation of the integrity of the sensory pathways being monitored.