Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
The Monitoring Committee of the Japanese Society for Spine Surgery and Related Research, Japan.
Spine (Phila Pa 1976). 2022 Jan 1;47(1):E27-E37. doi: 10.1097/BRS.0000000000004156.
A prospective multicenter observational study.
To elucidate the efficacy of transcranial motor-evoked potentials (Tc(E)-MEPs) in degenerative cervical myelopathy (DCM) surgery by comparing cervical spondylotic myelopathy (CSM) to cervical ossification of the posterior longitudinal ligament (OPLL) and investigate the timing of Tc(E)-MEPs alerts and types of interventions affecting surgical outcomes.
Although CSM and OPLL are the most commonly encountered diseases of DCM, the benefits of Tc(E)-MEPs for DCM remain unclear and comparisons of these two diseases have not yet been conducted.
We examined the results of Tc(E)-MEPs from 1176 DCM cases (840 CSM /336 OPLL) and compared patients background by disease, preoperative motor deficits, and the type of surgical procedure. We also assessed the efficacy of interventions based on Tc(E)-MEPs alerts. Tc(E)-MEPs alerts were defined as an amplitude reduction of more than 70% below the control waveform. Rescue cases were defined as those in which waveform recovery was achieved after interventions in response to alerts and no postoperative paralysis.
Overall sensitivity was 57.1%, and sensitivity was higher with OPLL (71.4%) than with CSM (42.9%). The sensitivity of acute onset segmental palsy including C5 palsy was 40% (OPLL/CSM: 66.7%/0%) whereas that of lower limb palsy was 100%. The most common timing of Tc(E)-MEPs alerts was during decompression (63.16%), followed by screw insertion (15.79%). The overall rescue rate was 57.9% (OPLL/CSM: 58.3%/57.1%).
Since Tc(E)-MEPs are excellent for detecting long tract injuries, surgeons need to consider appropriate interventions in response to alerts. The detection of acute onset segmental palsy by Tc(E)-MEPs was partially possible with OPLL, but may still be difficult with CSM. The rescue rate was higher than 50% and appropriate interventions may have prevented postoperative neurological complications.Level of Evidence: 3.
一项前瞻性多中心观察研究。
通过比较颈椎病（CSM）与颈椎后纵韧带骨化（OPLL），阐明经颅运动诱发电位（Tc（E）-MEPs）在退行性颈椎脊髓病（DCM）手术中的疗效，并探讨 Tc（E）-MEPs 警报的时机和影响手术结果的干预类型。
尽管 CSM 和 OPLL 是 DCM 最常见的疾病，但 Tc（E）-MEPs 对 DCM 的益处仍不清楚，而且尚未对这两种疾病进行比较。
我们检查了 1176 例 DCM 病例（840 例 CSM/336 例 OPLL）的 Tc（E）-MEPs 结果，并按疾病、术前运动障碍和手术类型比较了患者的背景。我们还根据 Tc（E）-MEPs 警报评估了干预措施的效果。Tc（E）-MEPs 警报定义为与对照波形相比，振幅降低超过 70%。挽救病例定义为在响应警报进行干预后波形恢复且无术后瘫痪的病例。
总体敏感性为 57.1%，OPLL（71.4%）的敏感性高于 CSM（42.9%）。急性节段性瘫痪（包括 C5 瘫痪）的敏感性为 40%（OPLL/CSM：66.7%/0%），而下肢瘫痪的敏感性为 100%。Tc（E）-MEPs 警报最常见的时间是在减压时（63.16%），其次是螺钉插入时（15.79%）。总体挽救率为 57.9%（OPLL/CSM：58.3%/57.1%）。
由于 Tc（E）-MEPs 非常适合检测长束损伤，因此外科医生需要考虑针对警报进行适当的干预。通过 Tc（E）-MEPs 检测 OPLL 引起的急性节段性瘫痪部分可能，但 CSM 仍可能难以检测。挽救率高于 50%，适当的干预措施可能防止了术后神经并发症。
3 级
