Intraoperative spinal cord monitoring using low intensity transcranial stimulation to remove post-activation depression of the H-reflex

Monitoring of transcranial motor evoked potentials (MEPs) is currently the preferred technique for assessing the integrity of motor pathways during spine surgery (Kothbauer et al. 1998; MacDonald et al. 2013). The presence of an MEP represents intact motor pathways (Kothbauer et al. 1998). In 1993, Taniguchi and colleagues introduced the technique of high-frequency (300-500 Hz) multi-pulse transcranial electrical stimulation (TES) to more consistently bring lower motor neurons (LMN) to firing threshold and produce a muscle MEP.

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