在治疗脊髓型颈椎病和神经根病的前路颈椎间盘切除融合术中常规使用术中神经监测存疑：15395例病例回顾
Routine Use of Intraoperative Neuromonitoring During ACDFs for the Treatment of Spondylotic Myelopathy and Radiculopathy Is Questionable: A Review of 15,395 Cases.
作者信息
Ajiboye Remi M, D'Oro Anthony, Ashana Adedayo O, Buerba Rafael A, Lord Elizabeth L, Buser Zorica, Wang Jeffrey C, Pourtaheri Sina
机构信息
UCLA Medical Center, Department of Orthopaedic Surgery, Los Angeles, CA.
Keck Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, CA.
出版信息
Spine (Phila Pa 1976). 2017 Jan 1;42(1):14-19. doi: 10.1097/BRS.0000000000001662.
STUDY DESIGN
A retrospective database study.
OBJECTIVE
The goal of this study was to (1) evaluate the trends in the use of intraoperative neuromonitoring (ION) for anterior cervical discectomy and fusion (ACDF) surgery in the United States and (2) assess the incidence of neurological injuries after ACDFs with and without ION.
SUMMARY OF BACKGROUND DATA
Somatosensory-evoked potentials (SSEPs) and motor-evoked potentials (MEPs) are the commonly used ION modalities for ACDFs. Controversy exists on the routine use of ION for ACDFs and there is limited literature on national practice patterns of its use.
METHODS
A retrospective review was performed using the PearlDiver Patient Record Database to identify cases of spondylotic myelopathy and radiculopathy that underwent ACDF from 2007 to 2014. The type of ION modality used and the rates of neurological injury after surgery were assessed.
RESULTS
During the study period, 15,395 patients underwent an ACDF. Overall, ION was used in 2627 (17.1%) of these cases. There was a decrease in the use of ION for ACDFs from 22.8% in 2007 to 4.3% use in 2014 (P < 0.0001). The ION modalities used for these ACDFs were quite variable: SSEPs only (48.7%), MMEPs only (5.3%), and combined SSEPs and MMEPs (46.1%). Neurological injuries occurred in 0.23% and 0.27% of patients with and without ION, respectively (P = 0.84). Younger age was associated with a higher utility of ION (<45: 20.3%, 45-54: 19.3%, 55-64: 16.6%, 65-74: 14.3%, and >75: 13.6%, P < 0.0001). Significant regional variability was observed in the utility of ION for ACDFs across the country (West; 21.9%, Midwest; 12.9% (P < 0.0001).
CONCLUSION
There has been a significant decrease in the use of ION for ACDFs. Furthermore, there was significant age and regional variability in the use of ION for ACDFs. Use of ION does not further prevent the rate of postoperative neurological complications for ACDFs as compared with the cases without ION. The utility of routine ION for ACDFs is questionable.
LEVEL OF EVIDENCE
研究设计
一项回顾性数据库研究。
目的
本研究的目的是（1）评估美国颈椎前路椎间盘切除融合术（ACDF）中术中神经监测（ION）的使用趋势，以及（2）评估使用和未使用ION的ACDF术后神经损伤的发生率。
背景数据总结
体感诱发电位（SSEPs）和运动诱发电位（MEPs）是ACDF常用的ION方式。ION在ACDF中的常规使用存在争议，关于其使用的全国实践模式的文献有限。
方法
使用PearlDiver患者记录数据库进行回顾性分析，以确定2007年至2014年接受ACDF的脊髓型颈椎病和神经根病病例。评估所使用的ION方式类型和术后神经损伤发生率。
结果
在研究期间，15395例患者接受了ACDF。总体而言，其中2627例（17.1%）使用了ION。ACDF中ION的使用从2007年的22.8%降至2014年的4.3%（P<0.0001）。这些ACDF所使用的ION方式差异很大：仅使用SSEPs（48.7%）、仅使用MMEPs（5.3%）以及SSEPs和MEPs联合使用（46.1%）。使用ION和未使用ION的患者中神经损伤发生率分别为0.23%和0.27%（P=0.84）。年龄较小与ION的更高使用率相关（<45岁：20.3%，45-54岁：19.3%，55-64岁：16.6%，65-74岁：14.3%，>75岁：13.6%，P<0.0001）。在全国范围内，ACDF中ION的使用存在显著的地区差异（西部；21.9%，中西部；12.9%（P<0.0001）。
结论
ACDF中ION的使用显著减少。此外，ACDF中ION的使用在年龄和地区方面存在显著差异。与未使用ION的病例相比，使用ION并不能进一步降低ACDF术后神经并发症的发生率。ACDF常规使用ION的效用值得怀疑。
证据级别
3级。
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