Stecker Mark M
Department of Neuroscience, Winthrop University Hospital, Mineola, NY, USA.
Surg Neurol Int. 2012;3(Suppl 3):S174-87. doi: 10.4103/2152-7806.98579. Epub 2012 Jul 17.
Intraoperative neurophysiologic monitoring (IONM) is a technique that is helpful for assessing the nervous system during spine surgery.
This is a review of the field describing the basic mechanisms behind the techniques of IONM. These include the most often utilized trancranial motor evoked potentials (Tc-MEPs), somatosensory evoked potentials (SSEPs), and stimulated and spontaneous EMG activity. It also describes some of the issues regarding practices and qualifications of practitioners.
Although the anatomic pathways responsible for the Tc-MEP and SSEP are well known and these clinical techniques have a high sensitivity and specificity, there is little published data showing that monitoring actually leads to improved patient outcomes. It is evident that IONM has high utility when the risk of injury is high, but may be only marginally helpful when the risk of injury is very low. The monitoring team must be well trained, be able to provide the surgeon feedback in real time, and coordinate activities with those of the surgical and anesthesia teams.
Although IONM is a valuable technique that provides sensitive and specific indications of neurologic injury, it does have limitations that must be understood. Maintaining a high quality of practice with appropriately trained personnel is critical.
术中神经生理监测(IONM)是一种有助于在脊柱手术期间评估神经系统的技术。
本文是对该领域的综述,描述了IONM技术背后的基本机制。这些机制包括最常使用的经颅运动诱发电位(Tc-MEP)、体感诱发电位(SSEP)以及刺激和自发肌电图活动。本文还描述了一些关于从业者的操作和资质的问题。
尽管负责Tc-MEP和SSEP的解剖学通路已为人熟知,且这些临床技术具有较高的敏感性和特异性,但几乎没有已发表的数据表明监测实际上能改善患者预后。显然,当损伤风险较高时,IONM具有很高的实用性,但当损伤风险非常低时,IONM可能帮助不大。监测团队必须接受良好的培训,能够实时向外科医生提供反馈,并与手术和麻醉团队协调活动。
尽管IONM是一种有价值的技术,能提供关于神经损伤的敏感且特异的指标,但它确实存在一些必须被理解的局限性。由经过适当培训的人员保持高质量的操作至关重要。