Neural Repair and Regeneration, University of Toronto Spine Program, University of Toronto Neuroscience Program, Toronto, ON, Canada.
Spine (Phila Pa 1976). 2010 Apr 20;35(9 Suppl):S37-46. doi: 10.1097/BRS.0b013e3181d8338e.
The objective of this article was to undertake a systematic review of the literature to determine whether IOM is able to sensitively and specifically detect intraoperative neurologic injury during spine surgery and to assess whether IOM results in improved outcomes for patients during these procedures.
Although relatively uncommon, perioperative neurologic injury, in particular spinal cord injury, is one of the most feared complications of spinal surgery. Intraoperative neuromonitoring (IOM) has been proposed as a method which could reduce perioperative neurologic complications after spine surgery.
A systematic review of the English language literature was undertaken for articles published between 1990 and March 2009. MEDLINE, EMBASE, and Cochrane Collaborative Library databases were searched, as were the reference lists of published articles examining the use of IOM in spine surgery. Two independent reviewers assessed the level of evidence quality using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria, and disagreements were resolved by consensus.
A total of 103 articles were initially screened and 32 ultimately met the predetermined inclusion criteria. We determined that there is a high level of evidence that multimodal IOM is sensitive and specific for detecting intraoperative neurologic injury during spine surgery. There is a low level of evidence that IOM reduces the rate of new or worsened perioperative neurologic deficits. There is very low evidence that an intraoperative response to a neuromonitoring alert reduces the rate of perioperative neurologic deterioration.
Based on strong evidence that multimodality intraoperative neuromonitoring (MIOM) is sensitive and specific for detecting intraoperative neurologic injury during spine surgery, it is recommended that the use of MIOM be considered in spine surgery where the spinal cord or nerve roots are deemed to be at risk, including procedures involving deformity correction and procedures that require the placement of instrumentation. There is a need to develop evidence-based protocols to deal with intraoperative changes in MIOM and to validate these prospectively.
本文旨在对文献进行系统回顾，以确定术中神经监测（IOM）是否能够敏感、特异地检测脊柱手术中的术中神经损伤，并评估 IOM 是否能改善这些手术患者的预后。
尽管围手术期神经损伤（特别是脊髓损伤）相对少见，但它是脊柱手术最可怕的并发症之一。术中神经监测（IOM）已被提议作为一种可降低脊柱手术后围手术期神经并发症的方法。
对 1990 年至 2009 年 3 月期间发表的英文文献进行了系统回顾。检索了 MEDLINE、EMBASE 和 Cochrane 协作图书馆数据库，以及审查术中神经监测在脊柱手术中应用的已发表文章的参考文献列表。两名独立评审员使用推荐评估、制定与评估（GRADE）标准评估证据质量水平，分歧通过共识解决。
最初筛选了 103 篇文章，最终有 32 篇符合预定的纳入标准。我们确定，多模态 IOM 对检测脊柱手术中的术中神经损伤具有高度敏感性和特异性，这一结论具有高度证据水平。有低水平证据表明，IOM 可降低新的或恶化的围手术期神经缺陷发生率。有非常低的证据表明，术中对神经监测警报的反应可降低围手术期神经恶化的发生率。
基于多模态术中神经监测（MIOM）对检测脊柱手术中的术中神经损伤具有高度敏感性和特异性的有力证据，建议在被认为脊髓或神经根存在风险的脊柱手术中考虑使用 MIOM，包括涉及畸形矫正和需要放置器械的手术。需要制定基于证据的 MIOM 术中变化处理方案，并前瞻性验证这些方案。
