术中监测数据的显著变化或丢失：12375 例脊柱手术 25 年的经验。
Significant change or loss of intraoperative monitoring data: a 25-year experience in 12,375 spinal surgeries.
机构信息
Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
出版信息
Spine (Phila Pa 1976). 2013 Jan 15;38(2):E101-8. doi: 10.1097/BRS.0b013e31827aafb9.
STUDY DESIGN
Retrospective.
OBJECTIVE
The purpose of this study was to report the spectrum of intraoperative events responsible for a loss or significant change in intraoperative monitoring (IOM) data.
SUMMARY OF BACKGROUND DATA
The efficacy of spinal cord/nerve root monitoring is demonstrated in a large, single institution series of patients, involving all levels of the spinal column (occiput to sacrum) and all spinal surgical procedures.
METHODS
Multimodality IOM included somatosensory-evoked potentials, descending neurogenic-evoked potentials, neurogenic motor-evoked potentials, and spontaneous and triggered electromyography. A total of 12,375 patients who underwent surgery for spinal pathology between January 1985 and December 2010 were reviewed. There were 59.3% female patients (7178) and 40.7% male patients (5197). Procedures by spinal level were as follows: cervical 29.7% (3671), thoracic/thoracolumbar 45.4% (5624), and lumbosacral 24.9% (3080). Age at the time of surgery was as follows: older than 18 years, 72.7% (242/8993) and younger than 18 years, 27.3% (144/3382). A total of 77.8% (9633) patients underwent primary surgical procedures and 22.2% (2742) patients underwent revision surgical procedures.
RESULTS
A total of 406 instances of IOM data change/loss occurred in 386 of 12,375 (3.1%) patients. Causes for data degradation/loss included the following: instrumentation (n = 131), positioning (n = 85), correction (n = 56), systemic (n = 49), unknown (n = 24), and focal spinal cord compression (n = 15). Data loss/change was seen in revision (6.1%/167 patients) surgical procedures more commonly than in primary procedures (2.3%/219 patients; P < 0.0001). Data improvement was demonstrated by 88.7% (n = 360) after intervention versus 11.3% (n = 46) with no improvement in IOM data. One patient with improved data after intervention versus 14 with no improvement despite intervention had a permanent neurological deficit (P < 0.0001).
CONCLUSION
IOM data identified 386 (3.1%) patients with loss/degradation of data in 12,375 spinal surgical procedures. Fortunately, in 93.3% of patients, intervention led to data recovery and no neurological deficits. Reduction from a potential (worst-case scenario) 3.1% (386) of patients with significant change/loss of IOM data to a permanent neurological deficit rate of 0.12% (15) patients was achieved (P < 0.0001), thus confirming efficacy of IOM.
研究设计
回顾性研究。
目的
本研究旨在报告导致术中监测（IOM）数据丢失或显著变化的术中事件谱。
背景资料总结
脊髓/神经根监测的疗效在一项涉及脊柱所有水平（枕骨至骶骨）和所有脊柱手术的大型单机构患者系列中得到证实。
方法
多模态 IOM 包括体感诱发电位、下行神经源性诱发电位、神经源性运动诱发电位以及自发性和触发肌电图。回顾了 1985 年 1 月至 2010 年 12 月期间因脊柱病变接受手术的 12375 例患者。女性患者占 59.3%（7178 例），男性患者占 40.7%（5197 例）。按脊柱水平进行的手术如下：颈椎 29.7%（3671 例）、胸椎/胸腰椎 45.4%（5624 例）和腰骶部 24.9%（3080 例）。手术时的年龄如下：18 岁以上 72.7%（242/8993 例），18 岁以下 27.3%（144/3382 例）。77.8%（9633 例）患者接受了初次手术，22.2%（2742 例）患者接受了翻修手术。
结果
在 12375 例患者中的 386 例（3.1%）中，共发生 406 例 IOM 数据变化/丢失。数据降级/丢失的原因包括以下：仪器（n=131）、定位（n=85）、矫正（n=56）、系统性（n=49）、未知（n=24）和局部脊髓压迫（n=15）。与初次手术（2.3%/219 例）相比，翻修手术（6.1%/167 例）中更常见 IOM 数据丢失/改变（P<0.0001）。经干预后，88.7%（n=360）的患者数据得到改善，而 11.3%（n=46）的患者数据无改善。1 例患者经干预后数据改善，而 14 例患者尽管干预但数据无改善，出现永久性神经功能缺损（P<0.0001）。
结论
在 12375 例脊柱手术中，IOM 数据确定了 386 例（3.1%）患者的数据丢失/降级。幸运的是，在 93.3%的患者中，干预导致数据恢复，无神经功能缺损。从潜在的（最坏情况）3.1%（386 例）有显著 IOM 数据变化/丢失的患者，到永久性神经功能缺损率为 0.12%（15 例）的患者，这一比例降低（P<0.0001），从而证实了 IOM 的疗效。
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