多模态术中神经生理监测在胸腰椎结核后凸矫正术中的作用。
The role of multi-modal intra-operative neurophysiological monitoring in corrective surgeries for thoracic tuberculosis with kyphosis.
机构信息
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Guo Xue Xiang, Chengdu, People's Republic of China.
出版信息
Acta Orthop Traumatol Turc. 2022 Jul;56(4):283-288. doi: 10.5152/j.aott.2022.22053.
OBJECTIVE
The aim of this study was to assess the performance and utility of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) during corrective surgery for thoracic tuberculosis with kyphosis (TTK).
METHODS
68 patients (mean age 31.7 ± 20.3 years) who underwent corrective surgery for TTK from 2012 to 2019 were included in this retrospective study. Patients were neurologicaly evaluated before and after surgery with systematic neurologic examinations. Intraoperative neurophysiological monitoring (IONM) with SSEP and MEP was carried out. A receiver operating characteristic (ROC) curve and area under ROC curve (AUC) were used to identify the diagnostic accuracy of potential recovery.
RESULTS
IONM alerting occurred in 12 surgeries (12/68, 17.6%), of which 6 were SSEP alerting, 2 MEP alerting, and 4 combinations of both SSEP and MEP. Among the 12 cases where there was IONM alerting, 3 (25%) had postoperative neurological deficits(PND), whereas one patient had PND without IONM alerting. IONM sensitivity and specificity were 0.75 (95% CI 0.22-0.99) and 0.86 (95% CI 0.74-0.93) respectively. Positive predictive value (PPV) and negative predictive value (NPV) were 0.25 and 0.98 respectively. The AUC of evoked potential recovery in diagnosing PND was 0.884.
CONCLUSION
Our study showed that multi-modal IONM with SSEP and MEP can effectively indicate a potential neural injury and predict PND during TTK corrective surgery.
LEVEL OF EVIDENCE
Level IV, Therapeutic Study.
目的
本研究旨在评估运动诱发电位（MEP）和体感诱发电位（SSEP）在胸腰椎结核后脊柱后凸矫正术中的表现和实用性。
方法
回顾性分析 2012 年至 2019 年期间接受胸腰椎结核后脊柱后凸矫正术的 68 例患者（平均年龄 31.7±20.3 岁）。所有患者在术前和术后均进行了系统的神经系统检查。术中采用 SSEP 和 MEP 进行神经生理监测（IONM）。采用受试者工作特征（ROC）曲线和 ROC 曲线下面积（AUC）来确定潜在恢复的诊断准确性。
结果
12 例手术（12/68，17.6%）发生 IONM 报警，其中 SSEP 报警 6 例，MEP 报警 2 例，SSEP 和 MEP 联合报警 4 例。在 12 例 IONM 报警的病例中，有 3 例（25%）术后出现神经功能缺损（PND），而 1 例无 IONM 报警的病例出现 PND。IONM 的灵敏度和特异性分别为 0.75（95%可信区间 0.22-0.99）和 0.86（95%可信区间 0.74-0.93）。阳性预测值（PPV）和阴性预测值（NPV）分别为 0.25 和 0.98。诱发电位恢复诊断 PND 的 AUC 为 0.884。
结论
本研究表明，SSEP 和 MEP 联合多模态 IONM 可有效提示潜在的神经损伤，并预测胸腰椎结核后脊柱后凸矫正术中的 PND。
证据等级
IV 级，治疗性研究。
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