Spinal Surgery

Table 53-15 surveys the many issues that may arise in the context of spinal cord and column procedures undertaken by neurosurgeons. The spinal cord has been described as a "microcosm of the brain"^[340] because its physiology is, in general, similar to that of the brain: CO₂ responsiveness, blood-"brain" barrier, autoregulation, high metabolic rate and blood flow (though somewhat less than the brain), and substantial ischemic vulnerability of gray matter. Measures to reduce spinal cord swelling analogous to ICP reduction maneuvers are, however, rarely used. The relevant electrophysiologic monitoring techniques are described in Chapter 38 . Prone positioning considerations and the phenomenon of POVL are addressed in the earlier section "Positioning."