Department of Orthopedic, The First Affiliated Hospital of Nanchang University, Nanchang, China.
Department of Spine Surgery, Orthopedic Research Institute, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
World Neurosurg. 2020 Jan;133:e225-e232. doi: 10.1016/j.wneu.2019.08.205. Epub 2019 Sep 4.
OBJECTIVE: To identify and reveal the sensitivity and efficiency of dynamic somatosensory evoked potentials (DSSEPs) in the diagnosis of cervical spondylotic myelopathy (CSM). METHODS: This retrospective study included 31 CSM and 15 control patients. All patients received SSEP examination with stimulation of median and ulnar nerves at neutral, flexed, and extended cervical positions; latency and amplitude were recorded at the C and C spinous processes and in the scalp over the primary sensory area (C). The percentage changes in latency and amplitude with dynamic motion were examined for each lead and compared between groups; the diagnostic cutoff values were determined using receiver operating characteristic curve analysis. RESULTS: All the patients with CSM received surgeries and were followed up for 1 year. Amplitude parameters varied with a dynamic position in both groups; all recorded dynamic SSEP indices except right median stimulus recorded at C5 spinous process, right ulnar stimulus recorded at scalp point C3, and right ulnar stimulus recorded at C2 spinous process were significantly different between groups (P < 0.05), but latency was not (P > 0.05). At the neutral position, the amplitude of left media stimulus recorded at C2 spinous process (LMC) was associated with CSM, but with low diagnostic accuracy (area under the curve = 0.199). At a dynamic position, the percentage change in amplitude of LMC and of left ulnar stimulus recorded at C2 spinous process (LUC) were determined to be diagnostic of CSM (P < 0.05), with areas under the curve of 0.891 and 0.912, respectively. Both records had high sensitivity and specificity in the diagnosis of CSM; the diagnostic cutoff values of LMC and LUC were calculated as 10.2% and 19.25%, respectively. CONCLUSIONS: The percentage change in amplitude was obvious during cervical dynamic motion, with records from LMC and LUC being predictive of CSM diagnosis; dynamic SSEPs provided a simple, accurate, and noninvasive supplementary test for the diagnosis of complicated CSM.
目的：确定并揭示动态体感诱发电位（DSSEP）在诊断颈椎病（CSM）中的敏感性和效率。
方法：本回顾性研究纳入了 31 例 CSM 患者和 15 例对照组患者。所有患者均接受正中神经和尺神经刺激的 SSEP 检查，检查时患者颈椎处于中立位、前屈位和后伸位；在 C 和 C 棘突以及头皮初级感觉区（C）记录潜伏期和振幅。检查每个导联的潜伏期和振幅随动态运动的变化百分比，并在组间进行比较；使用受试者工作特征曲线分析确定诊断截断值。
结果：所有 CSM 患者均接受手术治疗，并随访 1 年。两组患者的振幅参数均随体位的变化而变化；组间差异有统计学意义的所有记录的动态 SSEP 指标除了右侧正中神经刺激在 C5 棘突记录、右侧尺神经刺激在头皮 C3 点记录和右侧尺神经刺激在 C2 棘突记录（P < 0.05），潜伏期无差异（P > 0.05）。在中立位时，左侧正中神经刺激在 C2 棘突记录（LMC）的振幅与 CSM 相关，但诊断准确性较低（曲线下面积=0.199）。在动态位置时，LMC 和左侧尺神经刺激在 C2 棘突记录（LUC）的振幅变化百分比被确定为 CSM 的诊断指标（P < 0.05），曲线下面积分别为 0.891 和 0.912。两种记录方法在 CSM 的诊断中均具有较高的敏感性和特异性；LMC 和 LUC 的诊断截断值分别计算为 10.2%和 19.25%。
结论：颈椎动态运动时振幅变化明显，LMC 和 LUC 记录可预测 CSM 的诊断；动态 SSEP 为复杂 CSM 的诊断提供了一种简单、准确、无创的补充检测方法。
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