Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8560, Japan.
J Clin Neurosci. 2020 Nov;81:426-430. doi: 10.1016/j.jocn.2020.10.004. Epub 2020 Oct 24.
To perform spinal surgery safely, it is important to understand the risk factors, including factors that negatively influence intraoperative neuromonitoring (IONM). Transcranial motor evoked potentials (TcMEPs) are important in IONM. Therefore, we aimed to investigate whether muscle mass affects the waveforms of TcMEPs to understand the risk factors influencing TcMEPs. We enrolled 48 patients with thoracolumbar spinal diseases who underwent surgery at our facility between April 2015 and March 2018. Before surgery, the body composition, including muscle mass and fat mass, of all patients was measured using bioelectrical impedance analysis (BIA). During surgery, cranial stimulation under general anesthesia was used to derive TcMEPs, enabling us to measure the amplitude, using the control wave of the TcMEPs of the deltoid muscles and the abductor digiti minimi (ADM) muscles. We found a negative correlation between the amplitude of deltoid-muscle TcMEPs and muscle mass of the upper limb. The amplitude of deltoid-muscle TcMEPs did not correlate with the skeletal muscle index (SMI), muscle mass of the lower limb, or body fat mass. The amplitude of ADM-muscle TcMEPs did not correlate with SMI, muscle mass of any limb, or body fat mass. In conclusion, a larger muscle mass of the upper limb correlated with a lower amplitude of deltoid-muscle TcMEPs. By contrast, there was no correlation between the muscle mass of the upper limb and the amplitude of ADM-muscle TcMEPs. These findings suggest that TcMEPs of the ADM are less influenced by muscle mass and are more stable than those of the deltoid.
为了安全地进行脊柱手术，了解包括术中神经监测（IONM）产生负面影响的因素在内的风险因素非常重要。颅神经运动诱发电位（TcMEPs）在 IONM 中非常重要。因此，我们旨在研究肌肉质量是否会影响 TcMEPs 的波形，以了解影响 TcMEPs 的风险因素。我们纳入了 2015 年 4 月至 2018 年 3 月在我院接受手术治疗的 48 例胸腰椎疾病患者。所有患者在手术前均采用生物电阻抗分析（BIA）测量身体成分，包括肌肉质量和脂肪质量。手术期间，全身麻醉下进行颅刺激以获得 TcMEPs，从而可以测量三角肌和小趾展肌（ADM）TcMEPs 的控制波的振幅。我们发现三角肌 TcMEPs 的振幅与上肢肌肉质量呈负相关。三角肌 TcMEPs 的振幅与骨骼肌指数（SMI）、下肢肌肉质量或体脂质量均无相关性。ADM 肌肉 TcMEPs 的振幅与 SMI、任何肢体的肌肉质量或体脂质量均无相关性。总之，上肢肌肉质量越大，三角肌 TcMEPs 的振幅越低。相比之下，上肢肌肉质量与 ADM 肌肉 TcMEPs 的振幅之间没有相关性。这些发现表明 ADM 的 TcMEPs 受肌肉质量的影响较小，比三角肌 TcMEPs 更稳定。
