Roy E P, Gutmann L, Riggs J E, Jones E T, Byrd J A, Ringel R A
Department of Neurology, West Virginia University School of Medicine, Morgantown 26506.
Clin Orthop Relat Res. 1988 Apr(229):94-8.
During surgical correction of scoliosis, 63 patients had somatosensory evoked potential (SEP) monitoring of the spinal cord. Tibial nerves were unilaterally stimulated, and the potentials were recorded from the midcervical spine with surface and epidural needle electrodes. Over 85% had no significant change in their SEP and no postoperative neurologic deficits. Eleven percent had a significant change in their potential (amplitude decrease of greater than 60% and/or latency increase of greater than 2.5 msec) with no neurologic complications. One patient had a significant potential change and temporary postoperative sensory deficits did occur. One additional patient experienced postoperative neurologic complications but had no SEP change. This single false negative case, however, was clinically significant only for motor dysfunction, which is not monitored by the SEP. When changes in patient core temperature were compared to changes in SEP amplitude and latency, an intraoperative decrease in core temperature increased SEP latency and decreased amplitude, which may explain in part the false positive rate of the procedure.
在脊柱侧弯手术矫正过程中，63例患者接受了脊髓体感诱发电位（SEP）监测。单侧刺激胫神经，使用表面电极和硬膜外针电极从中颈椎记录电位。超过85%的患者SEP无显著变化，且术后无神经功能缺损。11%的患者电位有显著变化（波幅下降大于60%和/或潜伏期延长大于2.5毫秒），但无神经并发症。1例患者电位有显著变化，术后确实出现了暂时的感觉缺损。另有1例患者术后出现神经并发症，但SEP无变化。然而，这一单一的假阴性病例仅在运动功能障碍方面具有临床意义，而SEP并不监测运动功能。当将患者核心体温的变化与SEP波幅和潜伏期的变化进行比较时，术中核心体温下降会增加SEP潜伏期并降低波幅，这可能部分解释了该检查的假阳性率。
