需要对头颈重新定位，以恢复颈椎病手术定位时的电生理信号变化。

Need for head and neck repositioning to restore electrophysiological signal changes at positioning for cervical myelopathy surgery.

机构信息

Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, Spain.

出版信息

Neurocirugia (Astur : Engl Ed). 2022 Sep-Oct;33(5):209-218. doi: 10.1016/j.neucie.2021.03.002.

DOI:10.1016/j.neucie.2021.03.002

PMID:36084957

Abstract

OBJECTIVE

To evaluate the incidence of significant intraoperative electrophysiological signal changes during surgical positioning, and to assess the effectiveness of head and neck repositioning on the restoration of signals, among patients undergoing surgery for cervical myelopathy.

MATERIAL AND METHODS

We used multimodal intraoperative monitoring (somatosensory [SEP] and motor evoked potentials [MEP] and spontaneous electromyography) before and after patients' positioning in a consecutive cohort of 103 patients operated for symptomatic cervical myelopathy. Significant changes were defined as>50% attenuation in amplitude or>10% increase in latency of SEP, or abolishment or 50-80% attenuation of MEP.

RESULTS

Out of 103 patients (34.9% female, median age 54.5 years) 88 underwent laminectomy (85.4%) and 15 (14.6%) anterior approach. At the time of positioning, signal alterations occurred in 44 patients (42.7%), yet only 11 patients (10.7%) showed alarming changes. Immediate neck repositioning of these resulted in complete (n=6) or partial (n=4) restoration of potentials, yielding no postoperative deficits. The patient in which signals could not be restored after repositioning resulted in added postoperative deficit. The accuracy (true positives plus true negatives) of monitoring to detect new neurological deficits was 99.0% (102/103) for the entire cohort, and 100% (11/11) for those showing significant changes at the moment of positioning. Overall, only 1 patient, with non-significant SEP attenuation, experienced a new postoperative deficit, yielding a 0.97% rate of false negatives.

CONCLUSION

Among patients undergoing surgery for cervical myelopathy, 10.7% showed alarming electrophysiological signal changes at the time of positioning. Immediate repositioning of the neck resulted in near always restoration of potentials and avoidance of added neurological damage. Complete or partial restoration of potentials after repositioning yielded no postoperative deficits.

摘要

目的

评估颈椎脊髓病患者手术中手术体位改变时显著的术中电生理信号变化发生率，并评估头颈部重新定位对信号恢复的效果。

材料和方法

我们对连续 103 例因颈椎脊髓病接受手术治疗的患者进行了多模态术中监测（体感诱发电位[SEP]和运动诱发电位[MEP]和自发性肌电图），在患者定位前后使用。显著变化定义为 SEP 振幅衰减>50%或潜伏期增加>10%，或 MEP 消失或衰减 50-80%。

结果

在 103 例患者中（42.7%为女性，中位年龄 54.5 岁），88 例行椎板切除术（85.4%），15 例行前路手术（14.6%）。在定位时，44 例患者（42.7%）发生信号改变，但只有 11 例（10.7%）出现警报性改变。立即重新定位颈部导致电位完全（n=6）或部分（n=4）恢复，无术后缺陷。在重新定位后无法恢复信号的患者出现了新的术后缺陷。监测对检测新的神经功能缺损的准确性（真阳性加真阴性）在整个队列中为 99.0%（103/103），在定位时出现显著变化的患者中为 100%（11/11）。总的来说，只有 1 例患者（SEP 衰减无意义）出现新的术后缺陷，假阴性率为 0.97%。