Wang Shujie, Zhang Jianguo, Tian Ye, Shen Jianxiong, Zhao Yu, Zhao Hong, Li Shugang, Yu Bin, Weng Xisheng
Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing 100730, China.
Department of Orthopedics, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing 100730, China.
Spine J. 2017 Jun;17(6):777-783. doi: 10.1016/j.spinee.2015.09.028. Epub 2015 Oct 22.
Transcranial motor evoked potential (MEP) monitoring has been widely adopted in spine surgery, but so far the useful monitoring data for patients with preoperative spinal deficits (PPSDs) are limited. Originally we thought that they seemed technically more difficult and less reliable in performing the MEP monitoring to PPSDs.
Our objective was to study (1) the feasibility of MEP monitoring in PPSDs and the (2) the significance of rapid MEP loss.
STUDY DESIGN/SETTING: A retrospective case notes study from a prospective patient register was used as the study design.
A total of 332 PPSDs who underwent posterior spine surgery with a reliable MEP monitoring were collected between September 2010 and December 2014.
Relevant MEP loss was identified as rapid amplitude reduction (more than 80% MEP) associated with high-risk surgical maneuvers or high-risk diagnoses.
The muscles with higher strength were used to record the optimal MEP signal. MEP monitoring of these patients was considered to be feasible if reproducible signals had been obtained; moreover, sensitivity, specificity, positive predictive value (PPV), and negative predictive value were computed. The significance of the patients with rapid MEP loss was analyzed.
From a total of 332 PPSDs, 27 cases showed significant MEP loss (23 true positive, 4 false positive), and 21 showed new spinal deficits. Invalid MEP baselines were found in 11 paralysis and 6 severely incomplete paraplegia patients, and success rate of reliable MEP was 95.1% in PPSDs. The congenital kyphoscoliosis, tuberculous kyphoscoliosis, and thoracic spinal stenosis are considered high-risk diagnoses to result in MEP loss. The sensitivity of intraoperative MEP monitoring was 100%, the specificity 98.7%, the positive predictive value 85.2%, and the negative predictive value 100%.
Intraoperative MEP monitoring is feasible for most of the PPSDs. The rapid MEP loss during high-risk diagnoses and complicated surgical procedures may indicate new spinal deficits.
经颅运动诱发电位（MEP）监测已在脊柱手术中广泛应用，但目前针对术前存在脊髓功能缺损（PPSD）患者的有效监测数据有限。起初我们认为，对PPSD患者进行MEP监测在技术上似乎更具难度且可靠性较低。
我们的目标是研究（1）MEP监测在PPSD患者中的可行性，以及（2）MEP快速消失的意义。
研究设计/地点：采用一项基于前瞻性患者登记的回顾性病例记录研究作为研究设计。
2010年9月至2014年12月期间，共收集了332例接受后路脊柱手术且MEP监测可靠的PPSD患者。
相关MEP消失被定义为与高风险手术操作或高风险诊断相关的快速波幅降低（MEP降低超过80%）。
使用肌力较强的肌肉记录最佳MEP信号。如果获得了可重复的信号，则认为对这些患者进行MEP监测是可行的；此外，计算了敏感性、特异性、阳性预测值（PPV）和阴性预测值。分析了MEP快速消失患者的意义。
在332例PPSD患者中，27例出现显著的MEP消失（23例真阳性，4例假阳性），21例出现新的脊髓功能缺损。在11例瘫痪和6例严重不完全性截瘫患者中发现无效的MEP基线，PPSD患者中可靠MEP的成功率为95.1%。先天性脊柱后凸畸形、结核性脊柱后凸畸形和胸段椎管狭窄被认为是导致MEP消失的高风险诊断。术中MEP监测的敏感性为100%，特异性为98.7%，阳性预测值为85.2%，阴性预测值为100%。
术中MEP监测对大多数PPSD患者是可行的。在高风险诊断和复杂手术过程中MEP快速消失可能提示新的脊髓功能缺损。
