Feng Bin, Qiu Guixing, Shen Jianxiong, Zhang Jianguo, Tian Ye, Li Shugang, Zhao Hong, Zhao Yu
Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
J Spinal Disord Tech. 2012 Jun;25(4):E108-14. doi: 10.1097/BSD.0b013e31824d2a2f.
Retrospective review.
To evaluate the efficacy of multimodal intraoperative neuromonitoring for predicting iatrogenic neurological injury during surgical correction of a spine deformity and evaluate the potential risk factors for neurological monitoring changes.
Single modal intraoperative neuromonitoring is insufficient to predict neurological injury during surgical correction of spine deformity. Multimodal monitoring can provide more accuracy. Some risk factors were reported to be correlated with high rates of neurological deficits during scoliosis correction. But few studies have reported on the risk factors for neurological monitoring changes (NMCs).
The records of 176 consecutive patients who underwent surgery for the treatment of spinal deformities were reviewed. The patients were monitored using transcranial electric motor-evoked potential (MEP) and/or somatosensory-evoked potential (SEP). Alterations with the MEP wave amplitude decreasing more than 75% and SEP amplitude decreasing more than 50%, as compared with the baseline, were diagnosed as positive changes. Risk factors related to NMCs were evaluated, in light of preoperative neurological deficits, comorbidity of spinal cord deformity, procedure of osteotomy, main curve Cobb angle, and a diagnosis of kyphosis.
Combined MEP/SEP monitoring was successfully achieved in 175 of 176 cases. Eleven cases were presented with true NMCs according to MEPs. One patient had an irreversible neurological deficit and 4 patients had transient neurological deficits after waking up from the operation. SEP lagged MEP for an average of 15 minutes when both were presented with positive changes. The sensitivity and specificity of MEP were 91.7% and 98.8%, respectively. Solo SEP were 50% and 95.2%. Combined MEP and SEP were 92.9% and 99.4%. The procedure of osteotomy, curve Cobb angle more than 90 degrees, and preoperative kyphosis were correlated with a higher incidence of NMCs.
Multimodal intraoperative monitoring provides higher sensitivity for monitoring during spine deformity surgery and can predict events of neurological injury. The detection of NMCs and adjustment of surgical strategy may prevent irreversible neurological deficits. The possible risk factors for NMCs during spine deformity surgery include an osteotomy procedure, kyphosis correction, and preoperative Cobb angle more than 90 degrees.
回顾性研究。
评估多模式术中神经监测在预测脊柱畸形手术矫正过程中医源性神经损伤的疗效，并评估神经监测变化的潜在风险因素。
单一模式的术中神经监测不足以预测脊柱畸形手术矫正过程中的神经损伤。多模式监测可提供更高的准确性。据报道，一些风险因素与脊柱侧弯矫正过程中高比例的神经功能缺损相关。但很少有研究报道神经监测变化（NMCs）的风险因素。
回顾了176例连续接受脊柱畸形手术治疗患者的记录。使用经颅运动诱发电位（MEP）和/或体感诱发电位（SEP）对患者进行监测。与基线相比，MEP波幅下降超过75%且SEP波幅下降超过50%的变化被诊断为阳性变化。根据术前神经功能缺损、脊髓畸形合并症、截骨手术、主弯Cobb角和后凸畸形诊断，评估与NMCs相关的风险因素。
176例中的175例成功实现了MEP/SEP联合监测。根据MEP，11例出现真正的NMCs。1例患者出现不可逆的神经功能缺损，4例患者术后苏醒后出现短暂性神经功能缺损。当MEP和SEP均出现阳性变化时，SEP比MEP平均滞后15分钟。MEP的敏感性和特异性分别为91.7%和98.8%。单独SEP分别为50%和95.2%。MEP和SEP联合监测分别为92.9%和99.4%。截骨手术、Cobb角大于90度以及术前存在后凸畸形与NMCs的较高发生率相关。
多模式术中监测在脊柱畸形手术中提供了更高的监测敏感性，并可预测神经损伤事件。检测NMCs并调整手术策略可能预防不可逆的神经功能缺损。脊柱畸形手术中NMCs的可能风险因素包括截骨手术、后凸畸形矫正以及术前Cobb角大于90度。
