Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Spine (Phila Pa 1976). 2021 Dec 15;46(24):E1343-E1352. doi: 10.1097/BRS.0000000000004099.
This study is a meta-analysis of prospective and retrospective studies identified in PubMed, Web of Science, and Embase with outcomes of patients who received intraoperative somatosensory-evoked potential (SSEP) monitoring during lumbar spine surgery.
The objective of this study is to determine the diagnostic accuracy of intraoperative lower extremity SSEP changes for predicting postoperative neurological deficit. As a secondary analysis, we evaluated three subtypes of intraoperative SSEP changes: reversible, irreversible, and total signal loss.
Lumbar decompression and fusion surgery can treat lumbar spinal stenosis and spondylolisthesis but carry a risk for nerve root injury. Published neurophysiological monitoring guidelines provide no conclusive evidence for the clinical utility of intraoperative SSEP monitoring during lumbar spine surgery.
A systematic review was conducted to identify studies with outcomes of patients who underwent lumbar spine surgeries with intraoperative SSEP monitoring. The sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated and presented with forest plots and a summary receiver operating characteristic curve.
The study cohort consisted of 5607 patients. All significant intraoperative SSEP changes had a sensitivity of 44% and specificity of 97% with a DOR of 22.13 (95% CI, 11.30-43.34). Reversible and irreversible SSEP changes had sensitivities of 28% and 33% and specificities of 97% and 97%, respectively. The DORs for reversible and irreversible SSEP changes were 13.93 (95% CI, 4.60-40.44) and 57.84 (95% CI, 15.95-209.84), respectively. Total loss of SSEPs had a sensitivity of 9% and specificity of 99% with a DOR of 23.91 (95% CI, 7.18-79.65).
SSEP changes during lumbar spine surgery are highly specific but moderately sensitive for new postoperative neurological deficits. Patients who had postoperative neurological deficit were 22 times more likely to have exhibited intraoperative SSEP changes.Level of Evidence: 2.
本研究是对 PubMed、Web of Science 和 Embase 中前瞻性和回顾性研究的荟萃分析，研究对象为接受腰椎手术术中体感诱发电位（SSEP）监测的患者。
本研究旨在确定术中下肢 SSEP 变化预测术后神经功能缺损的诊断准确性。作为二次分析，我们评估了术中 SSEP 变化的三种亚型：可逆、不可逆和完全信号丢失。
腰椎减压融合术可治疗腰椎管狭窄症和脊椎滑脱症，但存在神经根损伤风险。已发布的神经生理学监测指南并未提供术中 SSEP 监测在腰椎手术中的临床实用性的明确证据。
进行了系统综述，以确定接受术中 SSEP 监测的腰椎手术患者的研究结果。计算了灵敏度、特异性和诊断优势比（DOR），并通过森林图和汇总受试者工作特征曲线进行了呈现。
研究队列包括 5607 名患者。所有显著的术中 SSEP 变化的灵敏度为 44%，特异性为 97%，DOR 为 22.13（95%CI，11.30-43.34）。可逆和不可逆 SSEP 变化的灵敏度分别为 28%和 33%，特异性分别为 97%和 97%。可逆和不可逆 SSEP 变化的 DOR 分别为 13.93（95%CI，4.60-40.44）和 57.84（95%CI，15.95-209.84）。完全丧失 SSEP 的灵敏度为 9%，特异性为 99%，DOR 为 23.91（95%CI，7.18-79.65）。
腰椎手术期间的 SSEP 变化对新出现的术后神经功能缺损具有高度特异性，但敏感性中等。发生术后神经功能缺损的患者发生术中 SSEP 变化的可能性是未发生术后神经功能缺损患者的 22 倍。
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