Silverstein Justin, Mermelstein Laurence, DeWal Hargovind, Basra Sushil
*Spine Medical Services, PLLC, Commack, NY †Department of Orthopedics, NorthShore-LIJ Huntington Hospital, Huntington, NY; and ‡Long Island Spine Specialists, PC, Commack, NY.
Spine (Phila Pa 1976). 2014 Jul 1;39(15):1254-60. doi: 10.1097/BRS.0000000000000357.
A retrospective analysis of a case series was performed.
To describe a novel technique to monitor femoral nerve function by analyzing the saphenous nerve somatosensory evoked potential (SSEP) during transpsoas surgical exposures of the lumbar spine.
During transpsoas direct lateral approaches to the lumbar spine, electromyography monitoring is frequently advocated; however, sensory and motor neurological complications are still being reported. Femoral nerve injury remains a feared complication at the L3-L4 and L4-L5 levels. The current neurophysiological monitoring modalities are not specific or sensitive enough to predict these injuries after the retractors are placed. The authors have developed a technique that is hypothesized to reduce femoral nerve injuries caused by retractor compression by adding saphenous nerve SSEPs to their neurophysiological monitoring paradigm.
Institutional review board approval was granted for this study and the medical records along with the intraoperative monitoring reports from 41 consecutive transpsoas lateral interbody fusion procedures were analyzed. The presence or absence of intraoperative changes to the saphenous nerve SSEP was noted and the postoperative symptoms and physical examination findings were noted.
SSEP changes were noted in 5 of the 41 surgical procedures, with 3 of the patients waking up with a femoral nerve deficit. None of the patients with stable SSEP's developed sensory or motor deficits postoperatively. No patient in this series demonstrated intraoperative electromyography changes indicative of an intraoperative nerve injury.
Saphenous nerve SSEP monitoring may be a beneficial tool to detect femoral nerve injury related to transpsoas direct lateral approaches to the lumbar spine.
对一系列病例进行回顾性分析。
描述一种在腰椎经腰大肌手术暴露过程中，通过分析隐神经体感诱发电位（SSEP）来监测股神经功能的新技术。
在腰椎经腰大肌直接外侧入路手术中，经常提倡进行肌电图监测；然而，感觉和运动神经并发症仍有报道。在L3 - L4和L4 - L5水平，股神经损伤仍然是令人担忧的并发症。目前的神经生理监测方式在预测牵开器放置后这些损伤方面不够特异或敏感。作者开发了一种技术，假设通过在神经生理监测模式中增加隐神经SSEP来减少牵开器压迫导致的股神经损伤。
本研究获得了机构审查委员会的批准，并分析了41例连续的经腰大肌外侧椎间融合手术的病历及术中监测报告。记录术中隐神经SSEP是否有变化，以及术后症状和体格检查结果。
41例手术中有5例出现SSEP变化，其中3例患者术后苏醒时出现股神经功能缺损。SSEP稳定的患者术后均未出现感觉或运动功能缺损。本系列中没有患者在术中出现提示术中神经损伤的肌电图变化。
隐神经SSEP监测可能是检测与腰椎经腰大肌直接外侧入路相关的股神经损伤的有益工具。
4级。
