Cheh Gene, Lenke Lawrence G, Padberg Anne M, Kim Yongjung J, Daubs Michael D, Kuhns Craig, Stobbs Georgia, Hensley Marsha
Wooridul Spine Hospital, St. Louis, MO, USA.
Spine (Phila Pa 1976). 2008 May 1;33(10):1093-9. doi: 10.1097/BRS.0b013e31816f5f73.
A retrospective review of pediatric kyphosis patients undergoing a spinal cord-level osteotomy for correction.
To evaluate the prevalence, etiology, timing, and intervention related to loss of spinal cord monitoring data during surgical correction of pediatric kyphosis in the spinal cord region.
Although much has been written regarding the risks inherent to scoliosis surgery, there is less literature available regarding the neurologic outcomes of pediatric kyphosis surgery. As more surgeons contemplate posterior-only kyphosis correction with spinal cord-level osteotomies, the importance of maintaining spinal cord neurologic function is paramount.
Forty-two patients with pediatric kyphosis undergoing a posterior-only spinal reconstruction with a spinal cord level osteotomy or posterior-based vertebral column resection performed were reviewed. Patients were categorized by diagnosis, type and incidence of osteotomies, and loss of neurogenic mixed-evoked potential (NMEP) data. Interventions required to regain data and postoperative neurologic outcomes were also reviewed.
Of the 42 patients, 9 (21.4%) demonstrated a complete loss of NMEP data sometime during surgery while concomitant somatosensory sensory-evoked potentials (SSEP) remained within acceptable limits of baseline values. All 9 patients had intraoperative intervention including: blood pressure elevation (n = 1), release of corrective forces (n = 2), blood pressure elevation and correction release (n = 3), malalignment/subluxation adjustment (n = 1), further bony decompression (n = 1), or restoration of anterior column height via a titanium cage along with further posterior decompression (n = 1). In all cases, SSEPs were unchanged and NMEPs returned varying from 8 to 20 minutes after loss, with all patients having a normal wake-up test intraoperatively and a normal neurologic examination after surgery.
Intraoperative multimodality monitoring with some form of motor tract assessment is a fundamental component of kyphosis correction surgery in the spinal cord region in order to create a safer, optimal environment and to minimize neurologic deficit. The surgeon must be able to trust the information monitoring provides and act on it accordingly.
对接受脊髓节段截骨矫正术的小儿脊柱后凸患者进行回顾性研究。
评估小儿脊柱后凸脊髓区域手术矫正过程中脊髓监测数据丢失的发生率、病因、时间及相关干预措施。
虽然已有大量关于脊柱侧弯手术固有风险的文献，但关于小儿脊柱后凸手术神经学转归的文献较少。随着越来越多的外科医生考虑采用脊髓节段截骨术进行单纯后路脊柱后凸矫正，维持脊髓神经功能的重要性至关重要。
回顾42例接受单纯后路脊髓节段截骨重建术或后路椎体柱切除术的小儿脊柱后凸患者。根据诊断、截骨类型和发生率以及神经源性混合诱发电位（NMEP）数据丢失情况对患者进行分类。还回顾了恢复数据所需的干预措施及术后神经学转归。
42例患者中，9例（21.4%）在手术过程中的某个时间点出现NMEP数据完全丢失，而同时体感诱发电位（SSEP）仍在基线值的可接受范围内。所有9例患者均接受了术中干预，包括：血压升高（n = 1）、解除矫正力（n = 2）、血压升高及矫正力解除（n = 3）、矫正不齐/半脱位调整（n = 1）、进一步骨质减压（n = 1）或通过钛笼恢复前柱高度并进一步后路减压（n = 1）。在所有病例中，SSEP未发生变化，NMEP在数据丢失后8至20分钟恢复，所有患者术中唤醒试验正常，术后神经学检查正常。
术中采用某种形式的运动通路评估进行多模式监测是脊髓区域脊柱后凸矫正手术的基本组成部分，以便创造更安全、优化的环境并使神经功能缺损最小化。外科医生必须能够信赖监测提供的信息并据此采取行动。
