术中神经监测在脊柱手术术前存在运动功能障碍患者中的适用性
The Applicability of Intraoperative Neuromonitoring in Patients with Preoperative Motor Weakness during Spine Surgery.
作者信息
Lee Jae Meen, Kim Dong Hwan, Kim Hwan Soo, Choi Byung Kwan, Han In Ho
机构信息
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Medical Research Institute, Pusan National University Hospital, Pusan National University College of Medicine, Busan, Korea.
出版信息
Korean J Spine. 2016 Mar;13(1):9-12. doi: 10.14245/kjs.2016.13.1.9. Epub 2016 Mar 31.
OBJECTIVE
The purpose of our study is to evaluate the success rate and feasibility of intraoperative neuromonitoring (IONM) focusing on transcranial motor evoked potential (TcMEP) monitoring for patients with preoperative motor weakness in spine surgery.
METHODS
Between November 2011 and December 2013, TcMEP and somatosensory evoked potential (SSEP) monitoring were attempted in 130 consecutive patients undergoing spine surgeries for cervical or thoracic cord lesions. Patients ranged in age from 14 to 81 years (mean±standard deviation, 56.7±14.8 years), and 84 patients were male. The success rates of both SSEP and MEPs monitoring were assessed according to the preoperative Medical Research Council (MRC) and Nurick grades.
RESULTS
TcMEP was recorded successfully in 0%, 28.6%, 72.3%, and 100% of patients with MRC grades 1, 2, 3, 4, and 5, respectively. SSEP was obtained from 0%, 37.5%, 21.5%, 61.4%, and 85.4% of patients with MRC grades 1, 2, 3, 4, and 5, respectively. TcMEP was recorded successfully in 84% of patients with Nurick grades 1-3 and 26% of patients with Nurick grades 4-5. SSEPs were recorded successfully in 76.3% of patients with Nurick grades 1-3 and 24% of patients with grades 4-5.
CONCLUSION
IONM during spine surgery may be useless in patients with MRC grades 1-2, applicable MRC grade 3, and useful MRC grades 4-5. MRC grade 3 is a critical point of indication for application of MEPs. In unmonitorable cases with MRC grade 3, increasing stimulus intensity or facilitation techniques may be considered to improve the usefulness of TcMEP.
目的
我们研究的目的是评估术中神经监测（IONM）聚焦于经颅运动诱发电位（TcMEP）监测对脊柱手术术前存在运动功能障碍患者的成功率和可行性。
方法
在2011年11月至2013年12月期间，对130例因颈髓或胸髓病变接受脊柱手术的连续患者尝试进行TcMEP和体感诱发电位（SSEP）监测。患者年龄范围为14至81岁（平均±标准差，56.7±14.8岁），其中84例为男性。根据术前医学研究委员会（MRC）和努里克分级评估SSEP和运动诱发电位（MEP）监测的成功率。
结果
MRC分级为1、2、3、4和5级的患者中，成功记录到TcMEP的比例分别为0%、28.6%、72.3%和100%。MRC分级为1、2、3、4和5级的患者中，成功获得SSEP的比例分别为0%、37.5%、21.5%、61.4%和85.4%。努里克分级为1 - 3级的患者中，84%成功记录到TcMEP；努里克分级为4 - 5级的患者中，26%成功记录到TcMEP。努里克分级为1 - 3级的患者中，76.3%成功记录到SSEP；努里克分级为4 - 5级的患者中，24%成功记录到SSEP。
结论
脊柱手术期间的IONM对MRC分级为1 - 2级的患者可能无用，对MRC 3级患者适用，对MRC 4 - 5级患者有用。MRC 3级是应用MEP的关键指征点。在MRC 3级无法监测的病例中，可考虑增加刺激强度或采用易化技术以提高TcMEP的有效性。
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