Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi Province, P.R. China.
The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China.
Spine (Phila Pa 1976). 2021 Sep 15;46(18):1226-1233. doi: 10.1097/BRS.0000000000003989.
Retrospective study.
To explore a relation between somatosensory- and motor-evoked potential (SEPs, MEPs) and corresponding thoracic cord function for thoracic spinal decompression surgery (TSDS) in patients with neurological deficit.
Although SEPs and MEPs monitoring has been developed as an essential technique in spinal surgery. There are limited data on the reliability of using SEPs and MEPs for TSDS and its prognosis.
One hundred twenty patients underwent TSDS in our hospital, 91 patients completed the trial. All the patients were divided into three subgroups according to the changes of MEPs and SEPs: neither SEPs nor MEP deteriorated -. Simply MEP deteriorated and both SEPs and MEP deteriorated -. Bispectral (BIS) was used to monitor the depth of sedation, which ranged from 40 to 60 by varying the infusion speed of anesthetics. The pre- and postoperative spinal function was assessed by muscle strength and Japanese Orthopaedic Association (JOA) score at three time points:1) before surgery; 2) immediately after general anesthesia recovery; 3) after 3-month follow-up.
Sixty-nine cases showed neither SEPs nor MEP deteriorated -, 10 cases showed only MEP deteriorated, and 12 cases showed both SEPs and MEP deteriorated -. The patients in the group where neither SEPs nor MEP deteriorated had the best recovery of the extremity muscle strength, the shortest recovery time (8.10 ± 1.60, P < 0.05), and toe movement time (8.50 ± 1.60, P < 0.05). There is a strong correlation between SEPs variability ratio at T4 time point and JOA recovery ratio (JOA RR) in the 3-month follow-up.
Combined SEPs and MEPs monitoring are important for TSDS in patients with neurological deficit and it is helpful for evaluating postoperative prognosis. It is more accurate to record SEPs at T4 time point to predict the patients' prognosis.Level of Evidence: 3.
回顾性研究。
探讨体感诱发电位（SEP）和运动诱发电位（MEP）与伴有神经功能缺损的胸椎减压手术（TSDS）中相应胸髓功能之间的关系。
虽然 SEP 和 MEP 监测已发展成为脊柱手术中的一项基本技术，但关于 SEP 和 MEP 用于 TSDS 及其预后的可靠性的数据有限。
我院共 120 例患者行 TSDS，91 例完成试验。所有患者根据 MEPs 和 SEPs 的变化分为三组：SEP 和 MEP 均无恶化组-，单纯 MEP 恶化组，SEP 和 MEP 均恶化组-。使用脑电双频指数（BIS）监测镇静深度，通过改变麻醉药物的输注速度，使 BIS 值在 40 至 60 之间变化。术前及术后 3 个月随访时通过肌力和日本矫形协会（JOA）评分评估脊髓功能，评估时间点 3 个：1）术前；2）全身麻醉苏醒即刻；3）术后 3 个月。
69 例患者 SEP 和 MEP 均无恶化，10 例患者单纯 MEP 恶化，12 例患者 SEP 和 MEP 均恶化。SEP 和 MEP 均无恶化组患者的四肢肌力恢复最好，恢复时间最短（8.10±1.60，P<0.05），脚趾运动时间最短（8.50±1.60，P<0.05）。T4 时间点 SEP 变异性比值与术后 3 个月的 JOA 恢复比值（JOA RR）有很强的相关性。
在伴有神经功能缺损的 TSDS 中，联合监测 SEP 和 MEP 非常重要，有助于评估术后预后。记录 T4 时间点的 SEP 更准确地预测患者的预后。
3 级
