畸形角度比与神经监测变化相关，而与脊柱切除无关：脊柱畸形的影响大于手术类型。
Deformity angular ratio is associated with neuromonitoring changes without a vertebral column resection: spinal deformity is more influential than type of surgery.
机构信息
Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS#69, Los Angeles, CA, 90027, USA.
出版信息
Spine Deform. 2023 Jul;11(4):951-956. doi: 10.1007/s43390-023-00669-y. Epub 2023 Mar 17.
PURPOSE
The purpose of this study is to investigate the effect of the deformity angular ratio (DAR) on intra-operative neuromonitoring (IONM) signal changes during posterior spinal fusion (PSF) without vertebral column resection (VCR).
METHODS
Retrospective review of severe pediatric spinal deformity patients treated with PSF without VCR or three-column osteotomy from 2008 to 2018. Exclusion criteria were prior instrumentation, lack of IONM, and incomplete radiographic data. Coronal DAR (C-DAR), sagittal DAR (S-DAR), and total DAR (T-DAR) were calculated and compared between patients with IONM signal loss and those without.
RESULTS
Two hundred and fifty-three patients met inclusion criteria. Forty-seven of two hundred and fifty-three (19%) patients had IONM signal loss. Intra-operative wake-up test was performed in seven cases; three of seven (43%) had a neurological deficit on wake-up test. All neurological deficits resolved at a mean of 41 days postop. IONM loss was associated with increased kyphosis (p = 0.003) and was not associated with Cobb angle (p = 0.16). S-DAR (p = 0.03) and T-DAR (p = 0.005) were associated with IONM signal loss but C-DAR was not (p = 0.06). Increased incidence of IONM signal loss was seen with S-DAR > 7 (p = 0.02) or T-DAR > 27 (p = 0.02). Twenty-four of ninety-two (26%) patients with S-DAR > 7 had IONM signal loss compared to twenty-three of one hundred and sixty-one (14%) with S-DAR ≤ 7 (OR, 2.1; 95% CI, 1.1-4.0). Seven of sixteen (44%) patients with T-DAR > 27 had signal loss compared to forty of two hundred and thirty-seven (17%) patients with T-DAR ≤ 27 (OR, 3.8; 95% CI, 1.3-10.9).
CONCLUSION
Patients with S-DAR > 7 or T-DAR > 27 have a higher risk of IONM loss during pediatric PSF even in the absence of a VCR or three-column osteotomies.
目的
本研究旨在探讨在不进行脊柱截骨术（VCR）的情况下，脊柱后路融合术（PSF）过程中畸形角比（DAR）对术中神经监测（IONM）信号变化的影响。
方法
回顾性分析 2008 年至 2018 年间，接受 PSF 治疗的严重儿童脊柱畸形患者的临床资料，排除标准为：术前有内固定、缺乏 IONM 或影像学资料不完整。计算冠状位 DAR（C-DAR）、矢状位 DAR（S-DAR）和总 DAR（T-DAR），并比较 IONM 信号丢失组和无信号丢失组之间的差异。
结果
253 例患者符合纳入标准。253 例患者中有 47 例（19%）发生 IONM 信号丢失。7 例患者术中行唤醒试验，其中 3 例（43%）唤醒时出现神经功能缺损。所有神经功能缺损均在术后平均 41 天恢复。IONM 信号丢失与后凸增加有关（p=0.003），与 Cobb 角无关（p=0.16）。S-DAR（p=0.03）和 T-DAR（p=0.005）与 IONM 信号丢失相关，但 C-DAR 无相关性（p=0.06）。S-DAR>7（p=0.02）或 T-DAR>27（p=0.02）时，IONM 信号丢失发生率增加。92 例 S-DAR>7 的患者中有 24 例（26%）发生 IONM 信号丢失，而 161 例 S-DAR≤7 的患者中有 23 例（14%）发生 IONM 信号丢失（OR，2.1；95%CI，1.1-4.0）。16 例 T-DAR>27 的患者中有 7 例（44%）发生信号丢失，而 237 例 T-DAR≤27 的患者中有 40 例（17%）发生信号丢失（OR，3.8；95%CI，1.3-10.9）。
结论
即使不进行 VCR 或三柱截骨术，S-DAR>7 或 T-DAR>27 的患者在进行儿童 PSF 时，IONM 信号丢失的风险更高。
Zotero 插件