Chen Jonathan H, Shilian Parastou, Cheongsiatmoy Justin, Gonzalez Andres A
Division of Intraoperative Neurophysiological Monitoring, Keck Hospital of University of Southern California, Los Angeles, California, U.S.A.
J Clin Neurophysiol. 2018 Sep;35(5):426-430. doi: 10.1097/WNP.0000000000000494.
Intraoperative neurophysiologic monitoring involves the use of various modalities, including somatosensory evoked potentials (SEP), to assess the integrity of the at-risk nervous system during surgeries. Reliable baseline tracings are important because they are data against which future tracings are compared to detect potential injury. In some cases, adequate baselines may be difficult to achieve. Therefore, we analyzed several patient-specific factors to determine which variables are associated with inadequate intraoperative SEP baseline signals.
This is a single-center, retrospective chart review of 631 consecutive patients who underwent spine or cranial surgeries between 2010 and 2011. Variables analyzed included age, glucose levels, diabetes mellitus type 2, hypertension, hyperlipidemia, height, weight, sex, smoking, preexisting neurologic conditions, surgical history, lower extremity edema, and neurologic examination findings. Association between these patient factors and baseline lower extremity SEP signals were analyzed.
Height, weight, neurologic deficits, lower extremity edema, and history of neurologic disease are each associated with inadequate baseline lower extremity SEPs after controlling for confounding variables. Baseline signals were able to be acquired in 94.1% of patients.
Adequate baselines are paramount for successful intraoperative neurophysiologic monitoring. However, certain patient-specific factors are associated with inadequate baseline SEP signals. Physical examination findings and a detailed chart review can be done to identify these factors and guide expectations during monitoring. Further research related to patient-specific factors amenable to modification can further improve our capacity to protect the nervous system during surgery.
术中神经生理监测涉及使用多种方式，包括体感诱发电位（SEP），以在手术期间评估高危神经系统的完整性。可靠的基线描记很重要，因为它们是用于与未来描记进行比较以检测潜在损伤的数据。在某些情况下，可能难以获得足够的基线。因此，我们分析了几个患者特异性因素，以确定哪些变量与术中SEP基线信号不足相关。
这是一项对2010年至2011年间连续631例行脊柱或颅脑手术患者的单中心回顾性图表审查。分析的变量包括年龄、血糖水平、2型糖尿病、高血压、高脂血症、身高、体重、性别、吸烟、既往神经疾病、手术史、下肢水肿和神经检查结果。分析了这些患者因素与基线下肢SEP信号之间的关联。
在控制混杂变量后，身高、体重、神经功能缺损、下肢水肿和神经疾病史均与基线下肢SEP不足相关。94.1%的患者能够获得基线信号。
足够的基线对于成功的术中神经生理监测至关重要。然而，某些患者特异性因素与基线SEP信号不足相关。可以进行体格检查和详细的图表审查以识别这些因素，并在监测期间指导预期。与可改变的患者特异性因素相关的进一步研究可以进一步提高我们在手术期间保护神经系统的能力。
