Kim Dong-Gun, Jo Seong-Rae, Park Young-Seop, Hyun Seung-Jae, Kim Ki-Jeong, Jahng Tae-Ahn, Kim Hyun-Jib, Park Kyung Seok
Department of Neurology, Myung Diagnostic Radiology Clinic, Seoul, Republic of Korea.
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Clin Neurophysiol Pract. 2017 Jan 9;2:48-53. doi: 10.1016/j.cnp.2016.12.006. eCollection 2017.
Anterior cervical discectomy and fusion (ACDF) surgery is the most common surgical procedure for the cervical spine with low complication rate. Despite the potential prognostic benefit, intraoperative neurophysiological monitoring (IONM), a method for detecting impending neurological compromise, is not routinely used in ACDF surgery. The present study aimed to identify the potential benefits of monitoring multi-channel motor evoked potentials (MEPs) during ACDF surgery.
We retrospectively reviewed 200 consecutive patients who received IONM with multi-channel MEPs and somatosensory evoked potentials (SSEPs). On average, 9.2 muscles per patient were evaluated under MEP monitoring.
The rate of MEP change during surgery in the multi-level ACDF group was significantly higher than the single-level group. Two patients from the single-level ACDF group (1.7%) and four patients from the multi-level ACDF group (4.9%) experienced post-operative motor deficits. Multi-channel MEPs monitoring during single and multi-level ACDF surgery demonstrated higher sensitivity, specificity, positive predictive and negative predictive value than SSEP monitoring.
Multi-channel MEP monitoring might be beneficial for the detection of segmental injury as well as long tract injury during single- and multi-level ACDF surgery.
This is first large scale study to identify the usefulness of multi-channel MEPs in monitoring ACDF surgery.
颈椎前路椎间盘切除融合术（ACDF）是治疗颈椎疾病最常见的手术方法，并发症发生率较低。尽管具有潜在的预后益处，但术中神经电生理监测（IONM），一种检测即将发生的神经功能损害的方法，在ACDF手术中并未常规使用。本研究旨在确定在ACDF手术中监测多通道运动诱发电位（MEP）的潜在益处。
我们回顾性分析了连续200例接受IONM监测多通道MEP和体感诱发电位（SSEP）的患者。平均而言，每位患者在MEP监测下评估9.2块肌肉。
多节段ACDF组手术期间MEP变化率显著高于单节段组。单节段ACDF组有2例患者（1.7%）和多节段ACDF组有4例患者（4.9%）出现术后运动功能障碍。单节段和多节段ACDF手术期间的多通道MEP监测显示出比SSEP监测更高的敏感性、特异性、阳性预测值和阴性预测值。
多通道MEP监测可能有助于在单节段和多节段ACDF手术中检测节段性损伤以及长束损伤。
这是第一项确定多通道MEP在监测ACDF手术中的有用性的大规模研究。
