Oya Junichi, Burke John F, Vogel Todd, Tay Bobby, Chou Dean, Mummaneni Praveen
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
World Neurosurg. 2017 Oct;106:17-25. doi: 10.1016/j.wneu.2017.06.026. Epub 2017 Jun 12.
Intraoperative neuromonitoring (IONM) has been reported to be sensitive and specific in the detection of neurologic injury during spinal surgery. The purpose of this study was to clarify the incidence of C5 palsy using multimodality IONM and to compare the accuracy of multimodality IONM to predict postoperative C5 palsy with isolated transcranial motor evoked potentials (MEPs).
We retrospectively reviewed 135 consecutive patients at a single institution with cervical spondylotic myelopathy who underwent open door laminoplasty using MEPs combined with somatosensory evoked potentials and free-running electromyography.
Multimodality IONM was obtained in 131 cases. Ossification of the posterior longitudinal ligament was present in 19 patients (14.1%). Postoperative C5 palsy occurred in 3 patients (2.2%). Significant MEP alerts occurred in 12 patients. Significant somatosensory evoked potential change was not observed. To predict acute-onset C5 palsy, MEP alerts in the deltoid or biceps had 100% sensitivity and 98.4% specificity. Transient or persistent MEP alerts in the deltoid or biceps had same positive predictive value with sensitivity of 50.0% and specificity 99.2%.
Incidence of any neurologic deficit, including C5 palsy, during laminoplasty while using multimodality IONM was relatively low. MEP alerts in the deltoids or biceps had 100% sensitivity and 98.4% specificity for predicting a postoperative deficit. Somatosensory evoked potentials did not appear to be helpful in predicting postoperative deficits.
据报道，术中神经监测（IONM）在脊柱手术中检测神经损伤方面具有敏感性和特异性。本研究的目的是明确使用多模式IONM时C5麻痹的发生率，并比较多模式IONM与单独经颅运动诱发电位（MEP）预测术后C5麻痹的准确性。
我们回顾性分析了一家机构连续135例患有颈椎病性脊髓病并接受开门椎板成形术的患者，术中使用了MEP联合体感诱发电位和自由运行肌电图。
131例患者获得了多模式IONM。19例患者（14.1%）存在后纵韧带骨化。3例患者（2.2%）发生术后C5麻痹。12例患者出现明显的MEP警报。未观察到明显的体感诱发电位变化。为预测急性发作的C5麻痹，三角肌或肱二头肌的MEP警报敏感性为100%，特异性为98.4%。三角肌或肱二头肌的短暂或持续MEP警报具有相同的阳性预测价值，敏感性为50.0%，特异性为99.2%。
在使用多模式IONM进行椎板成形术期间，包括C5麻痹在内的任何神经功能缺损的发生率相对较低。三角肌或肱二头肌的MEP警报对预测术后神经功能缺损的敏感性为100%，特异性为98.4%。体感诱发电位似乎无助于预测术后神经功能缺损。
