Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2022 Jun;162:e86-e90. doi: 10.1016/j.wneu.2022.02.080. Epub 2022 Feb 24.
Intraoperative neuromonitoring (IONM) is useful during spinal cord operations, but whether IONM is necessary for posterior cervical surgeries for degenerative conditions is unknown. We evaluated the utility of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring as a tool for predicting new postoperative neurologic deficits during posterior decompression and fusion for degenerative cervical spine conditions.
We retrospectively reviewed posterior cervical operations performed at our institute over a 4-year period. Patients with postoperative neurologic deficits were identified, and a detailed analysis performed to ascertain whether SSEP or MEP monitoring accurately predicted the onset of new postoperative deficits.
Overall, 498 patients were included in the analysis (median age 66 years; range: 22-93 years). SSEP monitoring was performed in all patients, and both SSEP and MEP monitoring were performed in 121 patients (24%). Twenty-one patients (4.2%) had new postoperative neurologic deficits. SSEP had significantly higher specificity (90%) but lower sensitivity (33%) than MEP (74% specificity [P = 0.008], 50% sensitivity [P = 0.01]) for detecting neurologic compromise intraoperatively. For SSEP, the positive predictive value (PPV) and negative predictive value (NPV) in detecting intraoperative changes that translated to new postoperative neurological deficits were 12% and 97%, respectively, whereas for MEP, the PPV and NPV were 6% (P = 0.009) and 98% (P = 0.20), respectively.
IONM during posterior cervical operations for degenerative conditions of the spine is not reliable at predicting new postoperative neurologic deficits in patients treated for degenerative conditions, but may provide peace of mind to the surgeon intraoperatively when no abnormalities are detected.
术中神经监测（IONM）在脊髓手术中很有用，但IONM 是否对退行性脊柱病变的颈椎后路手术有必要尚不清楚。我们评估体感诱发电位（SEP）和运动诱发电位（MEP）监测作为预测退行性颈椎病变后路减压融合术后新的术后神经功能缺损的工具的效用。
我们回顾性分析了我院 4 年内进行的颈椎后路手术。确定术后出现神经功能缺损的患者，并进行详细分析，以确定 SEP 或 MEP 监测是否准确预测新的术后缺损的发生。
共有 498 例患者纳入分析（中位年龄 66 岁；范围：22-93 岁）。所有患者均行 SEP 监测，121 例患者（24%）行 SEP 和 MEP 监测。21 例（4.2%）患者出现新的术后神经功能缺损。SEP 的特异性（90%）明显高于 MEP（74%；P=0.008），但敏感性（33%）低于 MEP（50%；P=0.01），SEP 用于术中检测神经功能损害。SEP 阳性预测值（PPV）和阴性预测值（NPV）分别为 12%和 97%，用于检测术中变化并转化为新的术后神经功能缺损，而 MEP 的 PPV 和 NPV 分别为 6%（P=0.009）和 98%（P=0.20）。
IONM 用于退行性脊柱病变的颈椎后路手术并不能可靠预测退行性病变患者术后新的神经功能缺损，但在未发现异常时可能为术者提供术中安心。
