Shigematsu Hideki, Ando Muneharu, Kobayashi Kazuyoshi, Yoshida Go, Funaba Masahiro, Morito Shinji, Takahashi Masahito, Ushirozako Hiroki, Kawabata Shigenori, Yamada Kei, Kanchiku Tsukasa, Fujiwara Yasushi, Taniguchi Shinichirou, Iwasaki Hiroshi, Tadokoro Nobuaki, Wada Kanichiro, Yamamoto Naoya, Yasuda Akimasa, Hashimoto Jun, Tani Toshikazu, Ando Kei, Machino Masaaki, Takatani Tsunenori, Matsuyama Yukihiro, Imagama Shiro
Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
Department of Orthopedic Surgery, Kansai Medical University, Osaka, Japan.
Global Spine J. 2023 Oct;13(8):2387-2395. doi: 10.1177/21925682221084649. Epub 2022 Mar 26.
Retrospective multicenter cohort study.
We aimed to clarify the efficacy of multimodal intraoperative neuromonitoring (IONM), especially in transcranial electrical stimulation of motor-evoked potentials (TES-MEPs) with spinal cord-evoked potentials after transcranial stimulation of the brain (D-wave) in the detection of reversible spinal cord injury in high-risk spinal surgery.
We reviewed 1310 patients who underwent TES-MEPs during spinal surgery at 14 spine centers. We compared the monitoring results of TES-MEPs with D-wave vs TES-MEPs without D-wave in high-risk spinal surgery.
There were 40 cases that used TES-MEPs with D-wave and 1270 cases that used TES-MEPs without D-wave. Before patients were matched, there were significant differences between groups in terms of sex and spinal disease category. Although there was no significant difference in the rescue rate between TES-MEPs with D-wave (2.0%) and TES-MEPs (2.5%), the false-positivity rate was significantly lower (0%) in the TES-MEPs-with-D-wave group. Using a one-to-one propensity score-matched analysis, 40 pairs of patients from the two groups were selected. Baseline characteristics did not significantly differ between the matched groups. In the score-matched analysis, one case (2.5%) in both groups was a case of rescue ( = 1), five (12.5%) cases in the TES-MEPs group were false positives, and there were no false positives in the TES-MEPs-with-D-wave group ( = .02).
TES-MEPs with D-wave in high-risk spine surgeries did not affect rescue case rates. However, it helped reduce the false-positivity rate.
回顾性多中心队列研究。
我们旨在阐明多模式术中神经监测（IONM）的疗效，尤其是在高危脊柱手术中，经颅电刺激运动诱发电位（TES-MEPs）联合经颅刺激大脑后的脊髓诱发电位（D波）在检测可逆性脊髓损伤方面的疗效。
我们回顾了14个脊柱中心1310例在脊柱手术中接受TES-MEPs监测的患者。我们比较了高危脊柱手术中TES-MEPs联合D波与不联合D波的监测结果。
40例患者使用了联合D波的TES-MEPs，1270例患者使用了不联合D波的TES-MEPs。在患者匹配前，两组在性别和脊柱疾病类别方面存在显著差异。尽管联合D波的TES-MEPs组的挽救率（2.0%）与TES-MEPs组（2.5%）之间无显著差异，但联合D波的TES-MEPs组的假阳性率显著更低（0%）。采用一对一倾向评分匹配分析，从两组中选取了40对患者。匹配组之间的基线特征无显著差异。在评分匹配分析中，两组各有1例（2.5%）为挽救病例（P = 1），TES-MEPs组有5例（12.5%）为假阳性，联合D波的TES-MEPs组无假阳性（P = 0.02）。
高危脊柱手术中联合D波的TES-MEPs不影响挽救病例率。然而，它有助于降低假阳性率。
