Thirumala Parthasarathy D, Melachuri Samyuktha R, Kaur Jaspreet, Ninaci David, Melachuri Manasa K, Habeych Miguel E, Crammond Donald J, Balzer Jeffrey R
Department of Neurological Surgery, Pittsburgh, PA.
Department of Neurology, University of Pittsburgh, Pittsburgh, PA.
Spine (Phila Pa 1976). 2017 Apr 1;42(7):490-496. doi: 10.1097/BRS.0000000000001882.
This study examined the diagnostic accuracy of significant changes of somatosensory evoked potentials (SSEPs) to evaluate and predict postoperative neurological deficits after posterior cervical fusions (PCF). Eight hundred forty six eligible patients underwent PCF at the University of Pittsburgh Medical Center (UPMC), from 2010 to 2012.
To assess the specificity and sensitivity of intraoperative monitoring in predicting postoperative neurological deficits during PCF.
We calculated the predictive value, including sensitivity and specificity, of changes in SSEPs to identify neurological deficits postoperatively. We used a receiver operating characteristic (ROC) curve with SSEP categories as cutoff values to further evaluate the diagnostic accuracy of change in SSEPs and postoperative neurological deficit.
All patients had preposition baselines and continuous SSEP monitoring throughout the surgery. Statistical analysis was completed using SPSS version 22 (IBM Corp., Armonk, NY).
Age and sex did not influence outcomes. Obesity affected patient outcome. The SSEP categories of significant changes and loss of responses resulted in a sensitivity/specificity of 0.30/0.96 and 0.16/0.98, respectively. The receiver operating characteristic curve has an area under the curve for significant change in/loss of SSEPs of 0.62/0.65 with a 95% confidence interval of 0.525 to 0.714/0.509 to 0.797.
Significant SSEP changes during PCF are a very specific but poorly sensitive indicator of postoperative neurological deficits. The odds ratio for significant changes in SSEPs and loss of waveforms was 9.80 and 11.82, respectively, with a 95% confidence interval of 4.695 to 20.46 and 4.45 to 31.41, respectively.
本研究检测体感诱发电位（SSEPs）显著变化的诊断准确性，以评估和预测颈椎后路融合术（PCF）后术后神经功能缺损情况。2010年至2012年期间，846例符合条件的患者在匹兹堡大学医学中心（UPMC）接受了PCF手术。
评估术中监测在预测PCF术后神经功能缺损方面的特异性和敏感性。
我们计算了SSEPs变化在识别术后神经功能缺损方面的预测价值，包括敏感性和特异性。我们使用以SSEP类别为临界值的受试者工作特征（ROC）曲线，进一步评估SSEPs变化和术后神经功能缺损的诊断准确性。
所有患者在手术前均有基线数据，并在整个手术过程中进行连续的SSEP监测。使用SPSS 22版（IBM公司，纽约州阿蒙克）完成统计分析。
年龄和性别不影响结果。肥胖影响患者预后。SSEPs显著变化和反应消失类别的敏感性/特异性分别为0.30/0.96和0.16/0.98。SSEPs显著变化/消失的受试者工作特征曲线下面积为0.62/0.65，95%置信区间为0.525至0.714/0.509至0.797。
PCF期间SSEPs的显著变化是术后神经功能缺损的一个非常特异但敏感性较差的指标。SSEPs显著变化和波形消失的优势比分别为9.80和11.82，95%置信区间分别为4.695至20.46和4.45至31.41。
1级。
