Kobayashi Kazuyoshi, Imagama Shiro, Ito Zenya, Ando Kei, Hida Tetsuro, Ito Kenyu, Tsushima Mikito, Ishikawa Yoshimoto, Matsumoto Akiyuki, Nishida Yoshihiro, Ishiguro Naoki
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Neurosurg Pediatr. 2017 Jan;19(1):108-115. doi: 10.3171/2016.6.PEDS16141. Epub 2016 Sep 30.
OBJECTIVE Corrective surgery for spinal deformities can lead to neurological complications. Several reports have described spinal cord monitoring in surgery for spinal deformity, but only a few have included patients younger than 20 years with adolescent idiopathic scoliosis (AIS). The goal of this study was to evaluate the characteristics of cases with intraoperative transcranial motor evoked potential (Tc-MEP) waveform deterioration during posterior corrective fusion for AIS. METHODS A prospective database was reviewed, comprising 68 patients with AIS who were treated with posterior corrective fusion in a prospective database. A total of 864 muscles in the lower extremities were chosen for monitoring, and acceptable baseline responses were obtained from 819 muscles (95%). Intraoperative Tc-MEP waveform deterioration was defined as a decrease in intraoperative amplitude of ≥ 70% of the control waveform. Age, Cobb angle, flexibility, operative time, estimated blood loss (EBL), intraoperative body temperature, blood pressure, number of levels fused, and correction rate were examined in patients with and without waveform deterioration. RESULTS The patients (3 males and 65 females) had an average age of 14.4 years (range 11-19 years). The mean Cobb angles before and after surgery were 52.9° and 11.9°, respectively, giving a correction rate of 77.4%. Fourteen patients (20%) exhibited an intraoperative waveform change, and these occurred during incision (14%), after screw fixation (7%), during the rotation maneuver (64%), during placement of the second rod after the rotation maneuver (7%), and after intervertebral compression (7%). Most waveform changes recovered after decreased correction or rest. No patient had a motor deficit postoperatively. In multivariate analysis, EBL (OR 1.001, p = 0.085) and number of levels fused (OR 1.535, p = 0.045) were associated with waveform deterioration. CONCLUSIONS Waveform deterioration commonly occurred during rotation maneuvers and more frequently in patients with a larger preoperative Cobb angle. The significant relationships of EBL and number of levels fused with waveform deterioration suggest that these surgical invasions may be involved in waveform deterioration.
目的 脊柱畸形矫正手术可能导致神经并发症。有几份报告描述了脊柱畸形手术中的脊髓监测，但只有少数报告纳入了年龄小于20岁的青少年特发性脊柱侧凸（AIS）患者。本研究的目的是评估AIS后路矫正融合术中经颅运动诱发电位（Tc-MEP）波形恶化病例的特征。方法 回顾了一个前瞻性数据库，其中包括68例在该前瞻性数据库中接受后路矫正融合治疗的AIS患者。总共选择了864条下肢肌肉进行监测，819条肌肉（95%）获得了可接受的基线反应。术中Tc-MEP波形恶化定义为术中波幅下降至对照波形的≥70%。对有和没有波形恶化的患者的年龄、Cobb角、柔韧性、手术时间、估计失血量（EBL）、术中体温、血压、融合节段数和矫正率进行了检查。结果 患者（3例男性和65例女性）平均年龄为14.4岁（范围11-19岁）。术前和术后的平均Cobb角分别为52.9°和11.9°，矫正率为77.4%。14例患者（20%）出现术中波形变化，这些变化发生在切口时（14%）、螺钉固定后（7%）、旋转操作期间（64%）、旋转操作后放置第二根棒时（7%）和椎间加压后（7%）。大多数波形变化在矫正减少或休息后恢复。术后无患者出现运动功能障碍。多因素分析显示，EBL（OR 1.001，p = 0.085）和融合节段数（OR 1.535，p = 0.045）与波形恶化有关。结论 波形恶化通常发生在旋转操作期间，且在术前Cobb角较大的患者中更常见。EBL和融合节段数与波形恶化的显著关系表明，这些手术侵袭可能与波形恶化有关。
