Sutter Martin, Eggspuehler Andreas, Muller Alfred, Dvorak Jiri
Department of Neurology, Spine Unit, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
Eur Spine J. 2007 Nov;16 Suppl 2(Suppl 2):S153-61. doi: 10.1007/s00586-007-0417-8. Epub 2007 Jul 26.
To describe different currently available tests of multimodal intraoperative monitoring (MIOM) used in spine and spinal cord surgery indicating the technical parameters, application and interpretation as an easy understanding systematic overview to help implementation of MIOM and improve communication between neurophysiologists and spine surgeons. This article aims to give an overview and proposal of the different MIOM-techniques as used daily in spine and spinal cord surgery at our institution. Intensive research in neurophysiology over the past decades has lead to a profound understanding of the spinal cord, nerve functions and their intraoperative functional evaluation in anaesthetised patients. At present, spine surgeons and neurophysiologist are faced with 1,883 publications in PubMed on spinal cord monitoring. The value and the limitations of single monitoring methods are well documented. The diagnostic power of the multimodal approach in a larger study population in spine surgery, as measured with sensitivity and specificity, is dealt with elsewhere in this supplement (Sutter et al. in Eur Spine J Suppl, 2007). This paper aims to give a detailed description of the different modalities used in this study. Description of monitoring techniques of the descending and ascending spinal cord and nerve root pathways by motor evoked potentials of the spinal cord and muscles elicited after transcranial electrical motor cortex, spinal cord, cauda equina and nerve root stimulation, continuous EMG, sensory cortical and spinal evoked potentials, as well as direct spinal cord evoked potentials applied on 1,017 patients. The method of MIOM, continuously adapted according to the site, stage of surgery and potential danger to nerve tissues, proved to be applicable with online results, reliable and furthermore teachable.
描述目前在脊柱和脊髓手术中使用的不同多模式术中监测（MIOM）测试，说明其技术参数、应用和解读，以提供一个易于理解的系统概述，帮助实施MIOM并改善神经生理学家与脊柱外科医生之间的沟通。本文旨在概述并介绍我们机构在脊柱和脊髓手术中日常使用的不同MIOM技术。过去几十年神经生理学的深入研究使人们对脊髓、神经功能及其在麻醉患者中的术中功能评估有了深刻的理解。目前，脊柱外科医生和神经生理学家在PubMed上可查阅到1883篇关于脊髓监测的出版物。单一监测方法的价值和局限性已有充分记录。本增刊其他地方讨论了多模式方法在更大规模脊柱手术研究人群中的诊断能力（以敏感性和特异性衡量）（Sutter等人，《欧洲脊柱杂志增刊》，2007年）。本文旨在详细描述本研究中使用的不同模式。描述了通过经颅电刺激运动皮层、脊髓、马尾和神经根后诱发的脊髓和肌肉运动诱发电位、连续肌电图、感觉皮层和脊髓诱发电位以及直接脊髓诱发电位对1017例患者进行脊髓和神经根下行及上行通路监测技术。根据手术部位、手术阶段和神经组织潜在危险不断调整的MIOM方法，被证明具有在线结果、可靠且可传授的特点。
