体感诱发电位在脊髓型颈椎病手术治疗中的预后价值

Prognostic value of somatosensory-evoked potentials in the surgical management of cervical spondylotic myelopathy.

作者信息

Hu Yong, Ding Yu, Ruan Dike, Wong Y W, Cheung Kenneth M C, Luk Keith D K

机构信息

Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong.

出版信息

Spine (Phila Pa 1976). 2008 May 1;33(10):E305-10. doi: 10.1097/BRS.0b013e31816f6c8e.

DOI:10.1097/BRS.0b013e31816f6c8e

PMID:18449030

Abstract

STUDY DESIGN

Preoperative somatosensory-evoked potentials (SEPs) were retrospectively analyzed and classified, and compared with surgical outcome.

OBJECTIVE

To evaluate the value of the preoperative SEP waveform in predicting the clinical outcome after surgical management of cervical spondylotic myelopathy (CSM).

SUMMARY OF BACKGROUND DATA

SEPs have played an important role in spinal surgery. However, the value of SEPs in predicting the outcome of surgery for CSM remains controversial.

METHODS

This study enrolled 76 CSM patients who underwent surgical intervention. Median nerve SEPs were recorded before surgery. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the neurologic function before surgery and at postoperative follow-up at 1, 3, 6, 12, and 24 months. Patients were divided into 5 groups according to the classification of their preoperative SEP waveforms. Group I patients had normal SEPs, group IIa had normal latency and abnormal amplitude, group IIb had abnormal latency and normal amplitude, group III had abnormal latency and amplitude, and group IV had immeasurable waveforms. The myelopathic disability scores and surgical outcomes in different groups were compared by the Kruskal-Wallis test.

RESULTS

The SEP classification was found to be significantly associated with the JOA score (Pearson's chi test, chi = 53.9, P < 0.05). There were no significant differences in JOA score recovery at different follow-up times within any SEP group. At 24 months after surgery, there was no significant difference in the recovery ratio between groups I and IIa, or between groups IIb and III (Kruskal-Wallis test, P > 0.05). However, the recovery ratio was significantly higher in groups I and IIa than in all the other groups (Kruskal-Wallis test, P < 0.05), and in groups IIb and III than in group IV (Kruskal-Wallis test, P < 0.05).

CONCLUSION

SEP classification correlates well with CSM disability and postoperative recovery ratio. Median nerve SEP recordings would be a valuable and practical tool for the diagnosis and prognosis of myelopathy.

摘要

研究设计

对术前体感诱发电位（SEP）进行回顾性分析和分类，并与手术结果进行比较。

目的

评估术前SEP波形在预测脊髓型颈椎病（CSM）手术治疗后临床结果中的价值。

背景资料总结

SEP在脊柱手术中发挥了重要作用。然而，SEP在预测CSM手术结果中的价值仍存在争议。

方法

本研究纳入76例行手术干预的CSM患者。术前记录正中神经SEP。采用日本骨科协会（JOA）评分系统评估术前及术后1、3、6、12和24个月随访时的神经功能。根据术前SEP波形分类将患者分为5组。I组患者SEP正常，IIa组潜伏期正常但波幅异常，IIb组潜伏期异常但波幅正常，III组潜伏期和波幅均异常，IV组波形无法测量。采用Kruskal-Wallis检验比较不同组的脊髓病残疾评分和手术结果。

结果

发现SEP分类与JOA评分显著相关（Pearson卡方检验，χ=53.9，P<0.05）。任何SEP组内不同随访时间的JOA评分恢复情况无显著差异。术后24个月，I组和IIa组之间、IIb组和III组之间的恢复率无显著差异（Kruskal-Wallis检验，P>0.05）。然而，I组和IIa组的恢复率显著高于所有其他组（Kruskal-Wallis检验，P<0.05），IIb组和III组的恢复率高于IV组（Kruskal-Wallis检验，P<0.05）。