Liu Xinyu, Konno Shunsuke, Miyamoto Masabumi, Gembun Yoshikazu, Horiguchi Gen, Ito Hiromoto
Department of Orthopedic Surgery, Nippon Medical School, Tokyo, Japan.
J Neurosurg Spine. 2009 Jul;11(1):71-8. doi: 10.3171/2009.3.SPINE08513.
The aim of this retrospective study was to evaluate the clinical usefulness of assessing lumbar somatosensory evoked potentials (SSEPs) in central lumbar spinal stenosis (LSS).
The latencies of lumbar SSEPs were recorded in 40 patients with central LSS, including 16 men and 24 women. The mean age of the patients was 67.3 +/- 7.4 years. The diagnosis was LSS in 23 cases and LSS associated with degenerative spondylolisthesis in 17 cases. The average duration of symptoms was 43.8 +/- 51.2 months. Twenty-two cases had bilateral and 18 cases had unilateral leg symptoms. Thirty-seven cases were associated with neurogenic intermittent claudication and the mean walking distance of patients with this condition was 246.8 +/- 232.7 m. The mean Japanese Orthopedic Association scale score, as well as the visual analog scale (VAS) scores of low-back pain, leg pain, and numbness, were 16.5 +/- 3.5, 6.0 +/- 2.5, 6.9 +/- 2.1, and 7.8 +/- 2.2, respectively. The minimal cross-sectional area of the dural sac on MR imaging was 0.44 +/- 0.21 cm(2). Thirty-nine cases of cervical spondylotic myelopathy without lumbar and peripheral neuropathy were chosen as the control group.
The latencies of lumbar SSEPs in patients with LSS and in the control group were 23.0 +/- 2.0 ms and 21.6 +/- 1.9 ms, respectively. There was a statistically significant difference between the LSS and control groups (p < 0.05). The latency of lumbar SSEPs was significant correlated with the VAS score of leg numbness (p < 0.05). The latency of lumbar SSEPs in LSS was clearly delayed when the VAS score of leg numbness was > or = 8 (p < 0.05).
Lumbar SSEPs are able to detect neurological deficit in the lumbar area effectively, and they can reflect part of the subjective severity of sensory disturbance (numbness) in LSS. Both lumbar SSEPs and VAS scores of leg numbness may be useful for clinical evaluation in patients with LSS.
本回顾性研究的目的是评估在中央型腰椎管狭窄症（LSS）中评估腰段体感诱发电位（SSEP）的临床实用性。
记录了40例中央型LSS患者的腰段SSEP潜伏期，其中男性16例，女性24例。患者的平均年龄为67.3±7.4岁。诊断为LSS的有23例，LSS合并退变性椎体滑脱的有17例。症状的平均持续时间为43.8±51.2个月。22例有双侧腿部症状，18例有单侧腿部症状。37例伴有神经源性间歇性跛行，该情况下患者的平均行走距离为246.8±232.7米。日本矫形外科学会量表平均评分以及腰痛、腿痛和麻木的视觉模拟量表（VAS）评分分别为16.5±3.5、6.0±2.5、6.9±2.1和7.8±2.2。磁共振成像上硬脊膜囊的最小横截面积为0.44±0.21平方厘米（2）。选择39例无腰椎及周围神经病变的脊髓型颈椎病患者作为对照组。
LSS患者和对照组的腰段SSEP潜伏期分别为23.0±2.0毫秒和21.6±1.9毫秒。LSS组与对照组之间存在统计学显著差异（p<0.05）。腰段SSEP潜伏期与腿部麻木的VAS评分显著相关（p<0.05）。当腿部麻木的VAS评分≥8时，LSS患者的腰段SSEP潜伏期明显延迟（p<0.05）。
腰段SSEP能够有效检测腰椎区域的神经功能缺损，并且可以反映LSS中感觉障碍（麻木）主观严重程度的一部分。腰段SSEP和腿部麻木的VAS评分对于LSS患者的临床评估可能都有用。
