Melachuri Samyuktha R, Kaur Jaspreet, Melachuri Manasa K, Ninaci David, Crammond Donald J, Balzer Jeffrey R, Thirumala Parthasarathy D
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA.
J Clin Neurosci. 2019 Mar;61:78-83. doi: 10.1016/j.jocn.2018.10.140. Epub 2018 Dec 4.
Lumbar interbody spinal fusion (LIF) surgeries are performed to treat or prevent back pain in patients with degenerated intervertebral discs and a variety of spinal diseases. However, post-operative neurological complications may ensue. Intraoperative monitoring techniques have been used to predict and potentially reduce the risk of complications.
This study examined the diagnostic accuracy of significant changes of somatosensory evoked potentials (SSEPs) to evaluate and predict post-operative neurological deficits after LIF. All patients underwent LIF at UPMC from 2010 to 2012. One thousand fifty-seven patients had pre-operative baseline and continuous intraoperative SSEP monitoring. Statistical analysis was completed using SPSS version 22. No relevant disclosure.
Patient outcomes were not significantly affected by age over 65, gender, obesity, and abnormal baselines. Lower extremity (LE) significant changes in SSEPs and LE loss of responses resulted in a sensitivity/specificity of 0.03/0.99 and 0.03/0.99; they had an AUC of 0.54/0.73 with a 95% confidence interval (CI) of [0.34, 0.74]/[0.29, 1.00].
Significant SSEP changes during LIF are a very specific but poorly sensitive indicator of perioperative neurological deficits. The odds ratio for LE loss of responses was 29.14 with a 95% CI of 1.79-475.5, so LE SSEP loss of responses can serve as a biomarker of perioperative neurological deficits after LIF.
腰椎椎间融合术（LIF）用于治疗或预防椎间盘退变及多种脊柱疾病患者的背痛。然而，术后可能会出现神经并发症。术中监测技术已被用于预测并潜在降低并发症风险。
本研究检测体感诱发电位（SSEP）显著变化的诊断准确性，以评估和预测LIF术后的神经功能缺损。2010年至2012年期间，所有患者均在匹兹堡大学医学中心接受LIF手术。1057例患者进行了术前基线和术中SSEP连续监测。使用SPSS 22版完成统计分析。无相关披露。
年龄超过65岁、性别、肥胖和基线异常对患者预后无显著影响。下肢SSEP显著变化和下肢反应消失的敏感性/特异性分别为0.03/0.99和0.03/0.99；其曲线下面积（AUC）分别为0.54/0.73，95%置信区间（CI）为[0.34, 0.74]/[0.29, 1.00]。
LIF术中SSEP显著变化是围手术期神经功能缺损的一个非常特异但敏感性较差的指标。下肢反应消失的优势比为29.14，95%CI为1.79 - 475.5，因此下肢SSEP反应消失可作为LIF术后围手术期神经功能缺损的生物标志物。
