Morris Susan H, Howard Jason J, Rasmusson Douglas D, El-Hawary Ron
*IWK Health Centre, Halifax, Nova Scotia, Canada †Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada ‡Division of Paediatric Orthopaedics, Sidra Medical and Research Center, Doha, Qatar; and §Department of Physiology & Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada.
Spine (Phila Pa 1976). 2015 Apr 15;40(8):E492-7. doi: 10.1097/BRS.0000000000000808.
Randomized controlled study of intraoperative transcranial motor evoked potentials (TcMEPs) as early indicators of neural compromise in a rat model of spinal cord compression.
To determine the temporal threshold at which a complete (100%) loss of intraoperative TcMEPs will result in significant postoperative functional deficits.
There is controversy about the best TcMEP alarm criteria for intraoperative spinal cord protection. Clinical trials provide some evidence, but randomized controlled trials, which are not feasible in humans, are lacking.
Twenty-four adult male Wistar rats were divided into 3 experimental groups according to the length of time that a 100% TcMEP signal loss was maintained; all animals had preoperative functional testing. After surgical placement of a balloon catheter in the thoracic sublaminar space, TcMEPs were recorded while the spinal cord was compressed by balloon inflation. The recordings were terminated after maintaining a 100% TcMEP loss for different time periods (0, 5, or 15 min). Functional behavioral testing was repeated after 24 hours.
Only the groups wherein the catheter was left inflated for 5 or 15 minutes after a complete (100%) loss of TcMEP amplitude showed a significant deterioration in functional testing as compared with preoperative baseline values. Functional testing remained normal for both the control group and the group in which termination of spinal cord compression occurred immediately after a decrease of TcMEP amplitude to 100%. There was a strong correlation between TcMEP amplitude recovery postintervention and functional ability at 24 hours postsurgery.
If a 100% loss of TcMEP signals is immediately recognized and reversed by rapid removal of the compressive force on the spinal cord, normal postoperative function was observed in this rat model. However, delaying intervention for even 5 minutes can result in significant postoperative functional deficits.
N/A.
在大鼠脊髓压迫模型中，将术中经颅运动诱发电位（TcMEPs）作为神经损伤早期指标的随机对照研究。
确定术中TcMEPs完全（100%）消失会导致显著术后功能缺陷的时间阈值。
关于术中脊髓保护的最佳TcMEP警报标准存在争议。临床试验提供了一些证据，但在人体中不可行的随机对照试验尚缺乏。
24只成年雄性Wistar大鼠根据TcMEP信号100%消失的持续时间分为3个实验组；所有动物术前均进行功能测试。在胸段椎板下间隙手术置入球囊导管后，通过球囊充气压迫脊髓时记录TcMEPs。在100%TcMEP消失不同时间段（0、5或15分钟）后终止记录。24小时后重复进行功能行为测试。
与术前基线值相比，仅在TcMEP波幅完全（100%）消失后球囊保持充气5或15分钟的组，功能测试出现显著恶化。对照组以及在TcMEP波幅降至100%后立即终止脊髓压迫的组，功能测试均保持正常。干预后TcMEP波幅恢复与术后24小时功能能力之间存在强相关性。
在该大鼠模型中，如果能立即识别并通过迅速解除脊髓压迫力使TcMEP信号100%消失得到逆转，则术后功能正常。然而，即使延迟干预5分钟也可能导致显著的术后功能缺陷。
无。
