Melachuri Samyuktha R, Stopera Carolyn, Melachuri Manasa K, Anetakis Katherine, Crammond Donald J, Castellano James F, Balzer Jeffrey R, Thirumala Parthasarathy D
Departments of1Neurological Surgery and.
2Neurology, University of Pittsburgh, Pennsylvania.
J Neurosurg Spine. 2020 Mar 6;33(1):35-40. doi: 10.3171/2019.12.SPINE191157. Print 2020 Jul 1.
Posterior thoracic fusion (PTF) is used as a surgical treatment for a wide range of pathologies. The monitoring of somatosensory evoked potentials (SSEPs) is used to detect and prevent injury during many neurological surgeries. The authors conducted a study to evaluate the efficacy of SSEPs in predicting perioperative lower-extremity (LE) neurological deficits during spinal thoracic fusion surgery.
The authors included patients who underwent PTF with SSEP monitoring performed throughout the entire surgery from 2010 to 2015 at the University of Pittsburgh Medical Center (UPMC). The sensitivity, specificity, odds ratio, and receiver operating characteristic curve were calculated to evaluate the diagnostic accuracy of SSEP changes in predicting postoperative deficits. Univariate analysis was completed to determine the impact of age exceeding 65 years, sex, obesity, abnormal baseline testing, surgery type, and neurological deficits on the development of intraoperative changes.
From 2010 to 2015, 771 eligible patients underwent SSEP monitoring during PTF at UPMC. Univariate and linear regression analyses showed that LE SSEP changes significantly predicted LE neurological deficits. Significant changes in LE SSEPs had a sensitivity and specificity of 19% and 96%, respectively, in predicting LE neurological deficits. The diagnostic odds ratio for patients with new LE neurological deficits who had significant changes in LE SSEPs was 5.86 (95% CI 2.74-12.5). However, the results showed that a loss of LE waveforms had a poor predictive value for perioperative LE deficits (diagnostic OR 1.58 [95% CI 0.19-12.83]).
Patients with new postoperative LE neurological deficits are 5.9 times more likely to have significant changes in LE SSEPs during PTF. Surgeon awareness of an LE SSEP loss may alter surgical strategy and positively impact rates of postoperative LE neurological deficit status. The relatively poor sensitivity of LE SSEP monitoring may indicate a need for multimodal neurophysiological monitoring, including motor evoked potentials, in thoracic fusion surgery.
胸椎后路融合术（PTF）被用作多种病症的外科治疗方法。体感诱发电位（SSEP）监测用于在许多神经外科手术中检测和预防损伤。作者开展了一项研究，以评估SSEP在预测胸椎融合手术围手术期下肢（LE）神经功能缺损方面的有效性。
作者纳入了2010年至2015年在匹兹堡大学医学中心（UPMC）接受全程SSEP监测的PTF患者。计算敏感性、特异性、比值比和受试者工作特征曲线，以评估SSEP变化在预测术后缺损方面的诊断准确性。完成单因素分析，以确定年龄超过65岁、性别、肥胖、基线测试异常、手术类型和神经功能缺损对术中变化发生情况的影响。
2010年至2015年，771例符合条件的患者在UPMC接受PTF期间接受了SSEP监测。单因素和线性回归分析表明，LE SSEP变化可显著预测LE神经功能缺损。LE SSEP的显著变化在预测LE神经功能缺损方面的敏感性和特异性分别为19%和96%。LE SSEP有显著变化的新发LE神经功能缺损患者的诊断比值比为5.86（95%CI 2.74 - 12.5）。然而，结果表明，LE波形消失对围手术期LE缺损的预测价值较差（诊断OR 1.58 [95%CI 0.19 - 12.83]）。
术后新发LE神经功能缺损的患者在PTF期间LE SSEP发生显著变化的可能性要高5.9倍。外科医生对LE SSEP消失的认识可能会改变手术策略，并对术后LE神经功能缺损状态发生率产生积极影响。LE SSEP监测相对较差的敏感性可能表明在胸椎融合手术中需要多模式神经生理监测，包括运动诱发电位。
