Langeloo Danielle D, Lelivelt Arjan, Louis Journée H, Slappendel Robert, de Kleuver Marinus
Department of Orthopaedics, Sint Maartenskliniek, Hengstdal 3, 6522 JV Nijmegen, the Netherlands.
Spine (Phila Pa 1976). 2003 May 15;28(10):1043-50. doi: 10.1097/01.BRS.0000061995.75709.78.
A descriptive historic cohort study was conducted.
To determine intraoperative response amplitude criteria for transcranial electrical motor-evoked potential monitoring that warn of neurologic damage, and to determine the additional value of monitoring six instead of two muscle sites.
Transcranial electrical motor-evoked potential monitoring provides immediate and reliable information about the integrity of the motor pathways during spine surgery. Although this monitoring technique is more frequently used, criteria for interpretation of the amplitude responses have not been defined.
The intraoperative monitoring outcomes were compared with the patient's clinical outcomes. The sensitivity, specificity, positive predictive value, and negative predictive value were determined for four different monitoring criteria.
Transcranial electrical motor-evoked potential monitoring was possible 142 of 145 patients undergoing corrective surgery. In this study, 16 patients had a neurologic event, and 11 patients showed recovery of response amplitude after a second surgical maneuver, whereas the remaining 5 patients had permanent partial neurologic damage. The criterion that at least one of six recordings must show an amplitude decrease of more than 80% was sufficiently strict to achieve a sensitivity of 1.0 and a specificity of 0.91. Less strict criteria, including recording at two instead of six sites, resulted in lower sensitivity, with the lower bound of the 95% confidence interval at 0.62.
Transcranial electrical motor-evoked potential monitoring allowed successful intraoperative monitoring. The criterion of one recording showing a response amplitude decrease of more than 80% during a surgical action can be considered a valuable warning criterion for neurologic damage. The authors also consider that monitoring at six instead of two muscles improves the value of neuromonitoring.
进行了一项描述性历史队列研究。
确定经颅电运动诱发电位监测术中提示神经损伤的反应幅度标准，并确定监测六个而非两个肌肉部位的附加价值。
经颅电运动诱发电位监测可在脊柱手术期间提供有关运动通路完整性的即时可靠信息。尽管这种监测技术使用得越来越频繁，但尚未定义反应幅度的解读标准。
将术中监测结果与患者的临床结果进行比较。针对四种不同的监测标准确定敏感性、特异性、阳性预测值和阴性预测值。
145例接受矫正手术的患者中有142例可行经颅电运动诱发电位监测。在本研究中，16例患者发生神经事件，11例患者在第二次手术操作后反应幅度恢复，而其余5例患者有永久性部分神经损伤。六项记录中至少有一项显示幅度下降超过80%的标准足够严格，敏感性达到1.0，特异性为0.91。不太严格的标准，包括在两个而非六个部位进行记录，导致敏感性较低，95%置信区间的下限为0.62。
经颅电运动诱发电位监测可实现术中成功监测。手术过程中一项记录显示反应幅度下降超过80%的标准可被视为神经损伤的有价值的警示标准。作者还认为，监测六个而非两个肌肉可提高神经监测的价值。
