Frazzetta Joseph N, Hofler Ryan C, Adams William, Schneck Michael J, Jones G Alexander
Neurosurgery, Loyola University Stritch School of Medicine, Maywood, USA.
Neurosurgery, Loyola University Medical Center, Maywood, USA.
Cureus. 2020 Dec 13;12(12):e12065. doi: 10.7759/cureus.12065.
Objective The objective of the study is to identify specific population groups that may benefit from intraoperative motor evoked potentials (MEP) and to assess positive predictive value (PPV) and negative predictive value (NPV) changes during operation by correlating these with postoperative motor outcomes. Methods We retrospectively reviewed 1,043 consecutive patient cases undergoing spine surgery with and without intraoperative monitoring (IOM) at a single institution from January 1, 2016 to December 31, 2017. Demographic and clinical outcome data were collected at multiple time points. An MEP amplitude decrease of 50% or greater was correlated with a motor deficit for this study. Results On multivariate analysis, patients with coronary artery disease and who received IOM were more likely to experience no new deficit (p=0.047) than those who did not receive IOM. Additionally, patients with hyperlipidemia and coronary artery disease (CAD) were less likely than those without to experience no new deficit (p=0.001 and p=0.02, respectively). MEP accounted for 244 cases, of which 15 had alert MEP criteria but no deficit for a PPV of 21.05% at day 1 post-operation. Day 7-30 PPV declined to 14.29%, and by day 90, there was no association. Conclusion Among patients in our study with CAD, IOM use was associated with significantly better outcomes. Patients with higher intraoperative blood loss, hyperlipidemia, and those with CAD were at increased risk of new neurological deficit. The use of motor evoked potentials was associated with low sensitivity and low PPV.
目的 本研究的目的是确定可能从术中运动诱发电位（MEP）中获益的特定人群，并通过将其与术后运动结果相关联来评估手术期间阳性预测值（PPV）和阴性预测值（NPV）的变化。方法 我们回顾性分析了2016年1月1日至2017年12月31日在单一机构接受脊柱手术且有或无术中监测（IOM）的1043例连续患者病例。在多个时间点收集人口统计学和临床结果数据。本研究将MEP波幅下降50%或更多与运动功能缺损相关联。结果 多因素分析显示，患有冠状动脉疾病且接受IOM的患者比未接受IOM的患者更有可能无新的功能缺损（p=0.047）。此外，患有高脂血症和冠状动脉疾病（CAD）的患者比未患这些疾病的患者更不容易无新的功能缺损（分别为p=0.001和p=0.02）。MEP涉及244例病例，其中15例符合MEP警示标准但无功能缺损，术后第1天的PPV为21.05%。术后第7至30天PPV降至14.29%，到第90天时，两者无关联。结论 在我们研究的患有CAD的患者中，使用IOM与明显更好的结果相关。术中失血量较多、患有高脂血症以及患有CAD的患者出现新的神经功能缺损的风险增加。运动诱发电位的使用与低敏感性和低PPV相关。
