Liu Tun, Yan Liang, Qi Huaguang, Luo Zhenguo, Liu Xuemei, Yuan Tao, Dong Buhuai, Zhao Yuanting, Zhao Songchuan, Li Houkun, Liu Zhian, Wu Xucai, Wang Fei, Wang Wentao, Huang Yunfei, Wang Gang
Department of Anesthesiology, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University Health Science Center, Xi'an, China.
Front Neurosci. 2022 Jun 10;16:879435. doi: 10.3389/fnins.2022.879435. eCollection 2022.
Intraoperative neuromonitoring (IONM) has become an increasingly essential technique in spinal surgery. However, data on the diagnostic value of IONM in predicting impending postoperative neurological deficits (PONDs) for patients who underwent posterior decompression surgery for thoracic spinal stenosis (TSS) are limited. Furthermore, patients who are at the highest risk of waveform changes during the surgery remain unknown. Our purpose was to (1) assess the diagnostic accuracy of IONM by combining somatosensory-evoked potential (SSEP) with motor-evoked potential (MEP) in predicting PONDs for patients who underwent the surgery and (2) identify the independent risk factors correlated with IONM changes in our study population.
A total of 326 consecutive patients who underwent the surgery were identified and analyzed. We collected the following data: (1) demographic and clinical data; (2) IONM data; and (3) outcome data such as details of PONDs, and recovery status (complete, partial, or no recovery) at the 12-month follow-up visit.
In total, 27 patients developed PONDs. However, 15, 6, and 6 patients achieved complete recovery, partial recovery, and no recovery, respectively, at the 12-month follow-up. SSEP or MEP change monitoring yielded better diagnostic efficacy in predicting PONDs as indicated by the increased sensitivity (96.30%) and area under the receiver operating characteristic (ROC) curve (AUC) value (0.91). Only one neurological deficit occurred without waveform changes. On multiple logistic regression analysis, the independent risk factors associated with waveform changes were as follows: preoperative moderate or severe neurological deficits ( = 0.002), operating in the upper- or middle-thoracic spinal level ( = 0.003), estimated blood loss (EBL) ≥ 400 ml ( < 0.001), duration of symptoms ≥ 3 months ( < 0.001), and impairment of gait ( = 0.001).
Somatosensory-evoked potential or MEP change is a highly sensitive and moderately specific indicator for predicting PONDs in posterior decompression surgery for TSS. The independent risks for IONM change were as follows: operated in upper- or middle-thoracic spinal level, presented with gait impairment, had massive blood loss, moderate or severe neurological deficits preoperatively, and had a longer duration of symptoms.
[http://www.chictr.org.cn]; identifier [ChiCTR 200003 2155].
术中神经监测（IONM）在脊柱手术中已变得越来越重要。然而，关于IONM对接受胸椎椎管狭窄（TSS）后路减压手术患者术后即将出现的神经功能缺损（PONDs）的诊断价值的数据有限。此外，手术期间波形变化风险最高的患者仍不明确。我们的目的是：（1）通过将体感诱发电位（SSEP）与运动诱发电位（MEP）相结合，评估IONM对接受该手术患者预测PONDs的诊断准确性；（2）在我们的研究人群中确定与IONM变化相关的独立危险因素。
共纳入并分析了326例连续接受该手术的患者。我们收集了以下数据：（1）人口统计学和临床数据；（2）IONM数据；（3）结局数据，如PONDs的详细情况以及12个月随访时的恢复状态（完全恢复、部分恢复或未恢复）。
共有27例患者出现PONDs。然而，在12个月随访时，分别有15例、6例和6例患者实现了完全恢复、部分恢复和未恢复。SSEP或MEP变化监测在预测PONDs方面具有更好的诊断效能，表现为敏感性增加（96.30%）和受试者操作特征（ROC）曲线下面积（AUC）值（0.91）升高。仅1例神经功能缺损发生时无波形变化。多因素logistic回归分析显示，与波形变化相关的独立危险因素如下：术前中度或重度神经功能缺损（P = 0.002）、在上胸段或中胸段脊柱水平进行手术（P = 0.003）、估计失血量（EBL）≥400 ml（P < 0.001）、症状持续时间≥3个月（P < 0.001）以及步态障碍（P = 0.001）。
体感诱发电位或MEP变化是预测TSS后路减压手术中PONDs的高度敏感且具有中度特异性的指标。IONM变化的独立危险因素如下：在上胸段或中胸段脊柱水平进行手术、存在步态障碍、大量失血、术前中度或重度神经功能缺损以及症状持续时间较长。
[http://www.chictr.org.cn]；标识符[ChiCTR 200003 2155]
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