在前路颈椎间盘切除融合术中采用术中自发肌电图监测对喉返神经刺激进行定量评估。

Quantitative estimation of the recurrent laryngeal nerve irritation by employing spontaneous intraoperative electromyographic monitoring during anterior cervical discectomy and fusion.

作者信息

Dimopoulos Vasilios G, Chung Induk, Lee Gregory P, Johnston Kim W, Kapsalakis Ioannis Z, Smisson Hugh F, Grigorian Arthur A, Robinson Joe S, Fountas Kostas N

机构信息

Department of Neurosurgery, Medical Center of Central Georgia, School of Medicine, Mercer University, Macon, GA, USA.

出版信息

J Spinal Disord Tech. 2009 Feb;22(1):1-7. doi: 10.1097/BSD.0b013e31815ea8b6.

DOI:10.1097/BSD.0b013e31815ea8b6

PMID:19190427

Abstract

STUDY DESIGN

Prospective, clinical study.

OBJECTIVE

The objective of our study was to evaluate the role of laryngeal intraoperative electromyography (IEMG) in predicting the development of postoperative recurrent laryngeal nerve (RLN) palsy in patients undergoing anterior cervical discectomy and fusion (ACDF). We also attempted to develop a method to quantify the total IEMG irritation of the RLN.

SUMMARY OF BACKGROUND DATA

RLN injury has been recognized as the most common ACDF-associated neurologic injury. It has been postulated, that the employment of laryngeal IEMG may identify the operative events leading to RLN injury and subsequent postoperative palsy.

METHODS

Laryngeal IEMG monitoring was performed in 298 patients undergoing ACDF. Preexistent baseline EMG activity, amplitude, and duration of IEMG activity were recorded. The total amount of RLN irritation was expressed as an Irritation Score (IS) applying a specially designed mathematical equation incorporating the amplitude, the duration, and the presence of any baseline EMG irritation. The relationship of IEMG activity with parameters such as the number of operative levels, the duration of the procedure, the presence of any previous neck surgeries, and the type of the used retractor was examined.

RESULTS

IEMG activity was recorded in 14.4% of our patients. Postoperative RLN injury occurred in 2.3% of our patients. The sensitivity of IEMG was 100%, the specificity 87%, the positive predictive value 16%, and its negative predictive value 97%. The calculated IS ranged between 0.28 and 3.47 (mean IS: 2.09). Significantly increased IEMG activity was found in patients with previous surgical intervention, patients undergoing multilevel procedures, long-lasting procedures, and cases in which self-retained retractors were used. Likewise, significantly increased IS were observed in patients with previous surgeries and in cases where self-retained retractors were used.

CONCLUSIONS

Our study indicates that laryngeal IEMG is a high-sensitivity modality that can provide real-time information and can potentially minimize the risk of operative RLN injury.

摘要

研究设计

前瞻性临床研究。

目的

本研究的目的是评估喉内肌电图（IEMG）在预测接受颈椎前路椎间盘切除融合术（ACDF）患者术后喉返神经（RLN）麻痹发生中的作用。我们还试图开发一种方法来量化RLN的总IEMG刺激程度。

背景数据总结

RLN损伤已被认为是ACDF相关最常见的神经损伤。据推测，使用喉IEMG可能识别导致RLN损伤及随后术后麻痹的手术事件。

方法

对298例接受ACDF的患者进行喉IEMG监测。记录IEMG活动的既往基线肌电活动、幅度和持续时间。RLN刺激总量用刺激评分（IS）表示，应用一个专门设计的数学公式，该公式纳入了幅度、持续时间以及任何基线肌电刺激的存在情况。研究了IEMG活动与诸如手术节段数、手术持续时间、既往是否有颈部手术以及所用牵开器类型等参数之间的关系。

结果

14.4%的患者记录到IEMG活动。2.3%的患者发生术后RLN损伤。IEMG的敏感性为100%，特异性为8�%，阳性预测值为16%，阴性预测值为97%。计算出的IS范围在0.28至3.47之间（平均IS：2.09）。在既往有手术干预的患者、接受多节段手术的患者、手术时间长的患者以及使用自持式牵开器的病例中，发现IEMG活动显著增加。同样，在既往有手术的患者以及使用自持式牵开器的病例中，观察到IS显著增加。