Tanaka Nobuhiro, Nakanishi Kazuyoshi, Fujimoto Yoshinori, Sasaki Hirofumi, Kamei Naosuke, Hamasaki Takahiko, Yamada Kiyotaka, Yamamoto Risako, Nakamae Toshio, Ochi Mitsuo
Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
J Neurosurg Spine. 2009 Oct;11(4):421-6. doi: 10.3171/2009.4.SPINE08584.
In this prospective analysis the authors describe the clinical results of surgical treatment in patients > 80 years of age in whom spinal function was evaluated with motor evoked potential (MEPs) monitoring.
The authors included 57 patients > 80 years of age who were suspected of having cervical myelopathy. The mean age of the patients was 83.0 years (range 80-90 years). The central motor conduction time (CMCT) was calculated from the latencies of the MEPs following transcranial magnetic stimulation and from M and F waves following peripheral nerve stimulation.
Preoperative electrophysiological evaluation demonstrated significant elongation of CMCT or abnormalities in MEP waveforms in 37 patients (65%), and 35 patients of these underwent laminoplasty. In 30 patients cervical spondylotic myelopathy was diagnosed and 5 patients ossification of the posterior longitudinal ligament was diagnosed. The preoperative mean Japanese Orthopaedic Association Scale score was 8.6 (range 3-12.5) and the mean postoperative score was 12.6 (range 6-14.5) with an average recovery rate of 45% (range -21 to 100%). There were no major complications in any of the patients during the operative period and there were no cases of death resulting from operative intervention.
Sufficient clinical results are expected even in patients with myelopathy who are older than 80 years of age, provided the patients are correctly selected by electrophysiological evaluation with MEPs and CMCT.
在这项前瞻性分析中，作者描述了对80岁以上患者进行手术治疗的临床结果，这些患者通过运动诱发电位（MEP）监测来评估脊髓功能。
作者纳入了57例80岁以上疑似患有颈椎病性脊髓病的患者。患者的平均年龄为83.0岁（范围80 - 90岁）。中央运动传导时间（CMCT）通过经颅磁刺激后MEP的潜伏期以及周围神经刺激后M波和F波的潜伏期来计算。
术前电生理评估显示37例患者（65%）CMCT显著延长或MEP波形异常，其中35例患者接受了椎板成形术。30例患者被诊断为颈椎病性脊髓病，5例患者被诊断为后纵韧带骨化。术前日本骨科协会量表平均评分为8.6（范围3 - 12.5），术后平均评分为12.6（范围6 - 14.5），平均恢复率为45%（范围 - 21至100%）。手术期间所有患者均未出现重大并发症，也没有因手术干预导致死亡的病例。
即使是80岁以上患有脊髓病的患者，如果通过MEP和CMCT进行电生理评估正确选择患者，也有望获得足够的临床结果。
