Fan Dapeng, Schwartz Daniel M, Vaccaro Alexander R, Hilibrand Alan S, Albert Todd J
Surgical Monitoring Associates, Inc., Bala Cynwyd, Pennsylvania 19004, USA.
Spine (Phila Pa 1976). 2002 Nov 15;27(22):2499-502. doi: 10.1097/00007632-200211150-00014.
A retrospective and prospective study was conducted to investigate intraoperative neurophysiologic monitoring during cervical laminectomy to detect iatrogenic C5 nerve root palsy.
To evaluate the usefulness of various intraoperative neuromonitoring methods for identifying C5 nerve root palsy.
One unsolved complication after laminectomy or laminoplasty for cervical compression myelopathy is C5 nerve root palsy. It can go undetected even in the presence of intraoperative neuromonitoring with conventional upper extremity mixed nerve or dermatomal somatosensory-evoked potentials or transcranial motor-evoked potentials, recording typically from hand muscles.
The intraoperative neuromonitoring data of 200 patients who underwent cervical laminectomy for myelopathy between 1998 and 2000 were reviewed for C5 nerve root palsy. Retrospective studies were conducted for the first 132 patients, who were monitored with conventional techniques including ulnar and posterior tibial nerve somatosensory-evoked potentials, C5-C7 dermatomally evoked potentials, and transcranial electrical motor-evoked potentials recorded from hand and leg muscles. Prospective studies then were applied to the remaining 68 patients, for whom transcranial electrical motor-evoked potentials and spontaneous electromyography were monitored from deltoid and biceps muscles in the wake of undetected C5 nerve root palsy from conventional neurophysiologic monitoring methods.
In the retrospective cohort, six patients presented after surgery with C5 nerve root palsy showing unilateral deltoid muscle paralysis despite entirely unremarkable conventional somatosensory-evoked potentials, dermatomally evoked potentials, and transcranial electrical motor-evoked potentials from hand and leg muscles. For the prospective cohort, two patients experienced postoperative iatrogenic C5 motor nerve root palsy. Impending C5 nerve root injuries after laminectomy were successfully identified in both patients showing significant changes in deltoid and biceps transcranial electrical motor-evoked potentials and spontaneous electromyography, thereby averting more serious consequence. There were no false-negative and false-positive results.
In an effort to reduce postoperative C5 nerve root palsy, the clinician should consider intraoperative deltoid and biceps transcranial electrical motor-evoked potential and spontaneous electromyography monitoring whenever there is potential for iatrogenic C5 nerve root injury.
进行了一项回顾性和前瞻性研究，以调查颈椎椎板切除术中的术中神经生理监测，以检测医源性C5神经根麻痹。
评估各种术中神经监测方法对识别C5神经根麻痹的有效性。
颈椎压迫性脊髓病行椎板切除术或椎板成形术后一个未解决的并发症是C5神经根麻痹。即使在术中使用传统的上肢混合神经或皮节体感诱发电位或经颅运动诱发电位进行神经监测（通常记录手部肌肉），也可能未被发现。
回顾了1998年至2000年间接受颈椎椎板切除术治疗脊髓病的200例患者的术中神经监测数据，以评估C5神经根麻痹情况。对前132例患者进行回顾性研究，这些患者采用传统技术进行监测，包括尺神经和胫后神经体感诱发电位、C5 - C7皮节诱发电位以及从手部和腿部肌肉记录的经颅电运动诱发电位。然后对其余68例患者进行前瞻性研究，对于这些患者，在传统神经生理监测方法未检测到C5神经根麻痹后，从三角肌和肱二头肌监测经颅电运动诱发电位和自发肌电图。
在回顾性队列中，6例患者术后出现C5神经根麻痹，表现为单侧三角肌麻痹，尽管来自手部和腿部肌肉的传统体感诱发电位、皮节诱发电位和经颅电运动诱发电位完全无异常。在前瞻性队列中，2例患者发生术后医源性C5运动神经根麻痹。在这2例患者中，均成功识别出椎板切除术后即将发生的C5神经根损伤，表现为三角肌和肱二头肌经颅电运动诱发电位和自发肌电图有显著变化，从而避免了更严重的后果。没有假阴性和假阳性结果。
为了减少术后C5神经根麻痹，临床医生在存在医源性C5神经根损伤可能性时，应考虑术中进行三角肌和肱二头肌经颅电运动诱发电位和自发肌电图监测。
