Kelleher Michael O, Tan Gamaliel, Sarjeant Roger, Fehlings Michael G
Spinal Program, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Ontario, Canada.
J Neurosurg Spine. 2008 Mar;8(3):215-21. doi: 10.3171/SPI/2008/8/3/215.
Despite the growing use of multimodal intraoperative monitoring (IOM) in cervical spinal surgery, limited data exist regarding the sensitivity, specificity, and predictive values of such a technique in detecting new neurological deficits in this setting. The authors sought to define the incidence of significant intraoperative electrophysiological changes and new postoperative neurological deficits in a cohort of patients undergoing cervical surgery.
The authors conducted a prospective analysis of a consecutive series of patients who had undergone cervical surgery during a 5-year period at a university-based neurosurgical unit, in which multimodal IOM was recorded. Sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) were determined using standard Bayesian techniques. The study population included 1055 patients (614 male and 441 female) with a mean age of 55 years.
The IOM modalities performed included somatosensory evoked potential (SSEP) recording in 1055 patients, motor evoked potential (MEP) recording in 26, and electromyography (EMG) in 427. Twenty-six patients (2.5%) had significant SSEP changes. Electromyographic activity was transient in 212 patients (49.6%), and 115 patients (26.9%) had sustained burst or train activity. New postoperative neurological deficits occurred in 34 patients (3.2%): 6 had combined sensory and motor deficits, 7 had new sensory deficits, 9 had increased motor weakness, and 12 had new root deficits. Of these 34 patients, 12 had spinal tumors, of which 7 were intramedullary. Overall, of the 34 new postoperative deficits, 21 completely resolved, 9 partially resolved, and 4 had no improvement. The deficits that completely resolved did so on average 3.3 months after surgery. Patients with deficits that did not fully resolve (partial or no improvement) were followed up for an average of 1.8 years after surgery. Somatosensory evoked potentials had a sensitivity of 52%, a specificity of 100%, a PPV of 100%, and an NPV of 97%. Motor evoked potential sensitivity was 100%, specificity 96%, PPV 96%, and NPV 100%. Electromyography had a sensitivity of 46%, specificity of 73%, PPV of 3%, and an NPV of 97%.
Combined neurophysiological IOM with EMG and SSEP recording and the selective use of MEPs is helpful for predicting and possibly preventing neurological injury during cervical spine surgery.
尽管多模式术中监测（IOM）在颈椎手术中的应用日益广泛，但关于该技术在检测此情况下新发神经功能缺损的敏感性、特异性和预测价值的数据有限。作者试图确定一组接受颈椎手术患者中显著术中电生理变化及术后新发神经功能缺损的发生率。
作者对一所大学神经外科单位在5年期间连续接受颈椎手术且记录了多模式IOM的一系列患者进行了前瞻性分析。使用标准贝叶斯技术确定敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。研究人群包括1055例患者（男性614例，女性441例），平均年龄55岁。
所进行的IOM模式包括1055例患者的体感诱发电位（SSEP）记录、26例患者的运动诱发电位（MEP）记录以及427例患者的肌电图（EMG）记录。26例患者（2.5%）出现显著SSEP变化。212例患者（49.6%）的肌电活动为短暂性，115例患者（26.9%）出现持续性爆发或串活动。34例患者（3.2%）术后出现新发神经功能缺损：6例有感觉和运动联合缺损，7例有新发感觉缺损，9例运动无力加重，12例有新发神经根缺损。在这34例患者中，12例患有脊柱肿瘤，其中7例为髓内肿瘤。总体而言，在34例术后新发缺损中，21例完全恢复，9例部分恢复，4例无改善。完全恢复的缺损平均在术后3.3个月恢复。缺损未完全恢复（部分恢复或无改善）的患者术后平均随访1.8年。体感诱发电位的敏感性为52%，特异性为100%，PPV为100%，NPV为97%。运动诱发电位的敏感性为100%，特异性为96%，PPV为96%，NPV为100%。肌电图的敏感性为46%，特异性为73%，PPV为3%，NPV为97%。
联合神经生理学IOM与EMG和SSEP记录以及选择性使用MEP有助于预测并可能预防颈椎手术期间的神经损伤。
