Hospital for the Sick Children, Toronto, Canada.
Spine (Phila Pa 1976). 2011 Sep 15;36(20):1627-38. doi: 10.1097/BRS.0b013e318216124e.
Retrospective review of 36 consecutive patients undergoing coronal plane deformity correction with intraoperative skull-femoral traction between 2005 and 2008 with motor evoked potential (MEP)/somatosensory evoked potential monitoring.
To determine the prevalence and significance of neurophysiological changes with intraoperative skull-femoral traction in adolescent idiopathic scoliosis.
Intraoperative skeletal traction can be associated with spinal cord stretching and ischemia with resultant electrophysiological changes. The prevalence and risks of such changes and their clinical significance is unknown.
Thirty-seven procedures involving 36 patients (27 females and 9 males) with a mean age of 14.8 (12-18) years were divided into two groups on the basis of the presence (group 1, n = 18 procedures) or absence (group 2, n = 19) of significant MEP changes with surgery. They were compared with patients undergoing correction without traction (group 3).
Significant differences among the groups were observed in mean preoperative Cobb angle (86° vs. 70° vs. 59°), mean intraoperative posttraction Cobb angle (50.0° vs. 34.6°), traction index (0.41 vs. 0.50), flexibility index (0.14 vs. 0.27 vs. 0.25), and presence of primary lumbar curves (0% vs. 32% vs. 14%). Initial onset of MEP amplitude loss (group 1) occurred at a mean of 94 (1-257) minutes from the onset of surgery, was bilateral in 13 procedures, and improved at a mean of 5.5 (1-29) minutes after decreasing or removing the traction. At closure, complete bilateral recovery to baseline was observed in 10 procedures, recovery to >50% baseline in five, and recovery to <50% baseline in three procedures. There were no neurologic deficits in this series.
Intraoperative traction is associated with frequent changes in MEP monitoring. The thoracic location of the major curve, increasing Cobb angle, and rigidity of major curve are significant risk factors for changes in MEP with traction. The presence of any MEP recordings irrespective of its amplitude at closure was associated with normal neurological function. Somatosensory evoked potential monitoring did not correlate with the traction induced MEP amplitude changes.
回顾性分析了 2005 年至 2008 年间 36 例行术中颅股骨牵引矫正冠状面畸形的连续患者，采用运动诱发电位（MEP）/体感诱发电位监测。
确定术中颅股骨牵引在青少年特发性脊柱侧凸中引起神经生理变化的发生率和意义。
术中骨骼牵引可能与脊髓拉伸和缺血有关，从而导致电生理变化。这种变化的发生率、风险及其临床意义尚不清楚。
37 例手术涉及 36 例患者（27 例女性，9 例男性），平均年龄 14.8（12-18）岁，根据手术中是否存在（组 1，n=18 例）或不存在（组 2，n=19 例）显著 MEP 变化分为两组。与未行牵引矫正的患者（组 3）进行比较。
组间平均术前 Cobb 角（86°比 70°比 59°）、术中牵引后 Cobb 角（50.0°比 34.6°）、牵引指数（0.41 比 0.50）、柔韧性指数（0.14 比 0.27 比 0.25）和原发性腰椎曲线存在率（0%比 32%比 14%）存在显著差异。MEP 幅度损失的初始发生（组 1）发生在手术开始后 94（1-257）分钟，13 例为双侧，在减少或去除牵引后 5.5（1-29）分钟平均改善。在关闭时，10 例完全双侧恢复到基线，5 例恢复到>50%基线，3 例恢复到<50%基线。该系列中无神经功能缺损。
术中牵引与 MEP 监测频繁变化有关。胸椎主曲线的位置、Cobb 角的增加和主曲线的僵硬性是与牵引相关的 MEP 变化的重要危险因素。无论其幅度如何，在关闭时存在任何 MEP 记录均与正常神经功能相关。体感诱发电位监测与牵引诱导的 MEP 幅度变化无关。
