Berends Hanneke I, Journée Henricus L, Rácz Ilona, van Loon Jan, Härtl Roger, Spruit Maarten
Department of Anesthesiology, Sint Maartenskliniek, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands.
Ortho-Spine Research Department, Sint Maartenskliniek, Nijmegen, The Netherlands.
Eur Spine J. 2016 May;25(5):1581-1586. doi: 10.1007/s00586-015-4182-9. Epub 2015 Aug 27.
To optimize intraoperative neuromonitoring during extreme lateral interbody fusion (XLIF) by adding transcranial electrical stimulation with motor evoked potential (TESMEP) to previously described monitoring using spontaneous EMG (sEMG) and peripheral stimulation (triggered EMG: tEMG).
Twenty-three patients with degenerative lumbar scoliosis had XLIF procedures and were monitored using sEMG, tEMG and TESMEP. Spontaneous and triggered muscle activity, and the MEP of 5 ipsilateral leg muscles, 2 contralateral leg muscles and 1 arm muscle were monitored.
During XLIF surgery decreased MEP amplitudes were measured in 9 patients and in 6 patients sEMG was documented. In 4 patients, both events were described. In 30 % of the cases (n = 7), the MEP amplitude decreased immediately after breaking of the table and even before skin incision. After reduction of the table break, the MEP amplitudes recovered to baseline. In two patients, the MEP amplitude deteriorated during distraction of the psoas with the retractor, while no events were reported using sEMG and tEMG. Repositioning of the retractor led to recovery of the MEP.
Monitoring the complete nervous system during an XLIF procedure is found to be helpful since nerve roots, lumbar plexus as well as the intradural neural structures may be at risk. TESMEP has additional value to sEMG and tEMG during XLIF procedure: (1) it informed about otherwise unnoticed events, and (2) it confirmed and added information to events measured using sEMG.
通过在先前描述的使用自发肌电图（sEMG）和外周刺激（触发肌电图：tEMG）的监测中增加经颅电刺激运动诱发电位（TESMEP），优化极外侧椎间融合术（XLIF）期间的术中神经监测。
23例退行性腰椎侧弯患者接受了XLIF手术，并使用sEMG、tEMG和TESMEP进行监测。监测自发和触发的肌肉活动，以及5条同侧腿部肌肉、2条对侧腿部肌肉和1条手臂肌肉的运动诱发电位。
在XLIF手术期间，9例患者测量到运动诱发电位幅度降低，6例患者记录到sEMG。4例患者同时出现这两种情况。在30%的病例（n = 7）中，手术台折断后甚至在皮肤切开前运动诱发电位幅度立即降低。手术台折断复位后，运动诱发电位幅度恢复到基线。2例患者在使用牵开器牵开腰大肌时运动诱发电位幅度恶化，而使用sEMG和tEMG未报告任何情况。重新放置牵开器后运动诱发电位恢复。
发现在XLIF手术期间监测整个神经系统是有帮助的，因为神经根、腰丛以及硬膜内神经结构可能处于危险之中。在XLIF手术期间，TESMEP对sEMG和tEMG具有附加价值：（1）它能告知其他未被注意到的情况，（2）它能确认并补充使用sEMG测量到的情况的信息。
