Wilent W Bryan, Trott Julie M, Sestokas Anthony K
Medical Department, SpecialtyCare, Brentwood, Tennessee.
Neurodiagn J. 2021 Mar;61(1):27-36. doi: 10.1080/21646821.2021.1866934.
MEPs are recommended for patients undergoing lumbar and lumbosacral procedures in which intraoperative neuromonitoring (IONM) is being utilized. While electromyography (EMG) provides critical nerve root proximity information, spontaneous EMG discharges are relatively poor at reliably diagnosing spinal nerve root dysfunction. In contrast, research indicates that MEPs are both sensitive and specific in diagnosing evolving spinal nerve root dysfunction. There is conflicting evidence, however, and it must be emphasized that the value of adding MEPs is only realized when practices and techniques are optimized. The ideal anesthetic plan is an optimized total intravenous anesthetic (TIVA) regimen. Selection of appropriate anesthetics and dosing is important for optimizing baseline response amplitudes and promoting diagnostic confidence in analyzing signal changes. An adaptive set of alert criteria that account for baseline amplitude and morphology fluctuations should guide the determination of significant signal change. The therapeutic impact of accurate diagnostic information depends on the timeliness of diagnosis and intervention. Prior to the start of surgery, a plan to obtain MEPs at least once every 10 minutes during the active part of the procedure and after every significant surgical maneuver should be agreed upon, and the intervention plan should include but not be limited to possible removal of hardware and release of retraction or distractive forces. In summary, MEPs can improve monitoring of at-risk nerve root function, but the accuracy and therapeutic impact of such monitoring depend on perioperative planning and communication that optimize use of this modality.
对于接受腰椎和腰骶部手术且术中使用神经监测（IONM）的患者，推荐使用运动诱发电位（MEP）。虽然肌电图（EMG）能提供关键的神经根邻近信息，但自发肌电图放电在可靠诊断脊神经根功能障碍方面相对较差。相比之下，研究表明运动诱发电位在诊断正在发展的脊神经根功能障碍方面既敏感又特异。然而，存在相互矛盾的证据，必须强调的是，只有在实践和技术得到优化时，增加运动诱发电位的价值才能得以实现。理想的麻醉方案是优化的全静脉麻醉（TIVA）方案。选择合适的麻醉药物和剂量对于优化基线反应幅度以及提高分析信号变化时的诊断信心很重要。一组考虑基线幅度和形态波动的适应性警报标准应指导对显著信号变化的判定。准确诊断信息的治疗影响取决于诊断和干预的及时性。在手术开始前，应商定一项计划，即在手术的活跃阶段至少每10分钟获取一次运动诱发电位，并在每次重大手术操作后获取，干预计划应包括但不限于可能移除硬件以及解除牵开或牵张力量。总之，运动诱发电位可以改善对高危神经根功能的监测，但这种监测的准确性和治疗影响取决于围手术期的规划和沟通，这些规划和沟通能优化这种监测方式的使用。
