Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
Spine (Phila Pa 1976). 2010 Jan 15;35(2):240-5. doi: 10.1097/BRS.0b013e3181c7c8f6.
Retrospective review.
The purpose of this study was to assess the preoperative neurologic risk in a consecutive series of spinal deformity patients undergoing correction surgery at one institution.
During spinal deformity correction surgery, neurologic monitoring techniques are commonly applied to reduce the risk of neurologic deficits. While previous studies have demonstrated risk factors for neurologic changes in the setting of spinal surgery, these involved long time spans and heterogeneous patient populations.
Of 301 cases performed over 1 year, 281 cases were monitorable. Patients were grouped according to diagnosis: neuromuscular (NM) scoliosis, Sagittal Plane deformity, and Scoliosis. Demographic and surgical data were collected for neurologically monitorable patients. Coronal and sagittal parameters were measured using digital images of radiographs. Neurologic status was measured with somatosensory-evoked potentials and/or motor-evoked potentials.
Primary NM scoliosis cases had the highest incidence of neurologic monitoring changes (NMC) (10%) while revision sagittal plane deformity had the second highest (9.8%). Sensitivity and specificity were both 100%. Overall incidence of neurologic deficit was 1.1%. Of the 13 NMCs patients, 3 patients had persistent neurologic deficit. Majority of NMCs occurred before deformity correction. In patients with NM scoliosis, NMCs increased with hybrid constructs with wires (P < 0.01). In patients with scoliosis, NMCs increased with increased body mass index, estimated blood loss, operative time, and postoperative coronal thoracolumbar curve magnitude (P < 0.04). In patients with primarily sagittal plane deformity, NMCs increased with preoperative proximal curve, postoperative proximal and thoracolumbar curves, and postoperative kyphosis and lordosis (P < 0.04).
Primary NM scoliosis and revision sagittal plane deformities appear to carry greatest incidence of NMCs during surgical intervention. Most observed NMCs did not result in a permanent neurologic deficit. Neuromonitoring should be assessed throughout the entire surgical procedure. This study may aid surgeons and patients to better assess neurologic risks related to spinal deformity surgery.
回顾性研究。
本研究旨在评估一家机构连续脊柱畸形患者接受矫形手术的术前神经风险。
在脊柱畸形矫正手术中，神经监测技术常用于降低神经功能缺损的风险。虽然先前的研究已经证明了脊柱手术中神经变化的危险因素，但这些研究涉及的时间跨度较长，患者人群也较为混杂。
在 1 年内进行的 301 例手术中，有 281 例可监测。根据诊断将患者分组：神经肌肉型（NM）脊柱侧凸、矢状面畸形和脊柱侧凸。收集可进行神经监测患者的人口统计学和手术数据。使用 X 光片的数字图像测量冠状面和矢状面参数。使用体感诱发电位和/或运动诱发电位测量神经状态。
原发性 NM 脊柱侧凸患者的神经监测变化发生率（NMC）最高（10%），其次是矢状面畸形翻修（9.8%）。敏感性和特异性均为 100%。总体神经功能缺损发生率为 1.1%。在 13 例 NMC 患者中，有 3 例患者存在持续性神经功能缺损。大多数 NMC 发生在畸形矫正之前。在 NM 脊柱侧凸患者中，带有钢丝的混合结构 NMC 增加（P < 0.01）。在脊柱侧凸患者中，NMC 随着 BMI、估计失血量、手术时间和术后冠状胸腰椎曲线幅度的增加而增加（P < 0.04）。在主要矢状面畸形患者中，NMC 随着术前近端曲度、术后近端和胸腰椎曲度以及术后后凸和前凸的增加而增加（P < 0.04）。
原发性 NM 脊柱侧凸和矢状面畸形翻修似乎在手术干预过程中导致 NMC 发生率最高。大多数观察到的 NMC 并未导致永久性神经功能缺损。应在整个手术过程中评估神经监测。本研究可能有助于外科医生和患者更好地评估脊柱畸形手术相关的神经风险。
