Eggspuehler Andreas, Sutter Martin A, Grob Dieter, Jeszenszky Dezsö, Porchet François, Dvorak Jiri
Department of Neurology/Spine Unit, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
Eur Spine J. 2007 Nov;16 Suppl 2(Suppl 2):S209-15. doi: 10.1007/s00586-007-0424-9. Epub 2007 Jul 4.
A prospective study of 246 patients who received multimodal intraoperative monitoring during cervical spine surgery between March 2000 and December 2005. To determine the sensitivity and specificity of MIOM techniques used to monitor spinal cord and nerve root function during cervical spine surgery. It is appreciated that complication rate of cervical spine surgery is low, however, there is a significant risk of neurological injury. The combination of monitoring of ascending and descending pathways may provide more sensitive and specific results giving immediate feedback information and/or alert regarding any neurological changes during the operation to the surgeon. Intraoperative somatosensory spinal and cerebral evoked potentials combined with continuous EMG and motor-evoked potentials of the spinal cord and muscles were evaluated and compared with postoperative clinical neurological changes. A total of 246 consecutive patients with cervical pathologies, majority spinal stenosis due to degenerative changes of cervical spine were monitored by means of MIOM during the surgical procedure. About 232 patients presented true negative while 2 patients false negative responses. About ten patients presented true positive responses where neurological deficit after the operation was predicted and two patients presented false positive findings. The sensitivity of MIOM applied during cervical spine procedure (anterior and/or posterior) was 83.3% and specificity of 99.2%. MIOM is an effective method of monitoring the spinal cord functional integrity during cervical spine surgery and can help to reduce the risk of neurological deficit by alerting the surgeon when monitoring changes are observed.
一项对2000年3月至2005年12月期间在颈椎手术中接受多模式术中监测的246例患者的前瞻性研究。目的是确定在颈椎手术中用于监测脊髓和神经根功能的多模式术中监测（MIOM）技术的敏感性和特异性。众所周知，颈椎手术的并发症发生率较低，然而，存在显著的神经损伤风险。对上行和下行通路的监测相结合可能会提供更敏感和特异的结果，在手术过程中为外科医生提供有关任何神经变化的即时反馈信息和/或警报。对术中体感脊髓和脑诱发电位与脊髓和肌肉的连续肌电图及运动诱发电位进行评估，并与术后临床神经学变化进行比较。共有246例连续的颈椎病变患者，大多数因颈椎退变导致椎管狭窄，在手术过程中通过MIOM进行监测。约232例患者呈真阴性，2例患者呈假阴性反应。约10例患者呈真阳性反应，术后出现神经功能缺损得到预测，2例患者出现假阳性结果。在颈椎手术（前路和/或后路）中应用MIOM的敏感性为83.3%，特异性为99.2%。MIOM是颈椎手术中监测脊髓功能完整性的有效方法，当观察到监测变化时可提醒外科医生，有助于降低神经功能缺损的风险。
