Shigematsu Hideki, Kawaguchi Masahiko, Hayashi Hironobu, Takatani Tsunenori, Iwata Eiichiro, Tanaka Masato, Okuda Akinori, Morimoto Yasuhiko, Masuda Keisuke, Tanaka Yuu, Tanaka Yasuhito
Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan.
Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara City, Nara 6348522, Japan.
Spine J. 2017 Oct;17(10):1472-1479. doi: 10.1016/j.spinee.2017.05.004. Epub 2017 May 5.
During spine surgery, the spinal cord is electrophysiologically monitored via transcranial electrical stimulation of motor-evoked potentials (TES-MEPs) to prevent injury. Transcranial electrical stimulation of motor-evoked potential involves the use of either constant-current or constant-voltage stimulation; however, there are few comparative data available regarding their ability to adequately elicit compound motor action potentials. We hypothesized that the success rates of TES-MEP recordings would be similar between constant-current and constant-voltage stimulations in patients undergoing spine surgery.
The objective of this study was to compare the success rates of TES-MEP recordings between constant-current and constant-voltage stimulation.
This is a prospective, within-subject study.
Data from 100 patients undergoing spinal surgery at the cervical, thoracic, or lumbar level were analyzed.
The success rates of the TES-MEP recordings from each muscle were examined.
Transcranial electrical stimulation with constant-current and constant-voltage stimulations at the C3 and C4 electrode positions (international "10-20" system) was applied to each patient. Compound muscle action potentials were bilaterally recorded from the abductor pollicis brevis (APB), deltoid (Del), abductor hallucis (AH), tibialis anterior (TA), gastrocnemius (GC), and quadriceps (Quad) muscles.
The success rates of the TES-MEP recordings from the right Del, right APB, bilateral Quad, right TA, right GC, and bilateral AH muscles were significantly higher using constant-voltage stimulation than those using constant-current stimulation. The overall success rates with constant-voltage and constant-current stimulations were 86.3% and 68.8%, respectively (risk ratio 1.25 [95% confidence interval: 1.20-1.31]).
The success rates of TES-MEP recordings were higher using constant-voltage stimulation compared with constant-current stimulation in patients undergoing spinal surgery.
在脊柱手术中，通过经颅电刺激运动诱发电位（TES-MEP）对脊髓进行电生理监测以预防损伤。经颅电刺激运动诱发电位涉及使用恒流或恒压刺激；然而，关于它们充分引出复合运动动作电位能力的比较数据很少。我们假设在接受脊柱手术的患者中，恒流和恒压刺激下TES-MEP记录的成功率相似。
本研究的目的是比较恒流和恒压刺激下TES-MEP记录的成功率。
这是一项前瞻性的自身对照研究。
分析了100例接受颈椎、胸椎或腰椎手术的患者的数据。
检查每条肌肉TES-MEP记录的成功率。
在每位患者的C3和C4电极位置（国际“10-20”系统）施加恒流和恒压经颅电刺激。从双侧拇短展肌（APB）、三角肌（Del）、拇展肌（AH）、胫前肌（TA）、腓肠肌（GC）和股四头肌（Quad）双侧记录复合肌肉动作电位。
使用恒压刺激时，右侧Del、右侧APB、双侧Quad、右侧TA、右侧GC和双侧AH肌肉的TES-MEP记录成功率显著高于使用恒流刺激时。恒压和恒流刺激的总体成功率分别为８６．３％和６８．８％（风险比1.25[95％置信区间：1.20-1.31]）。
在接受脊柱手术的患者中，与恒流刺激相比，恒压刺激下TES-MEP记录的成功率更高。
