胸椎管狭窄症患者术中神经生理学监测：其可行性和新的神经功能缺损高危因素。
Intra-Operative Neurophysiological Monitoring in Patients with Thoracic Spinal Stenosis: Its Feasibility and High-Risk Factors for New Neurological Deficit.
机构信息
Department of Spine Surgery, Nanjing Drum Tower Hospital Clinical College of Xuzhou Medical University, Nanjing, 210008, China.
Division of Spine Surgery, Department of Orthopaedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
出版信息
Orthop Surg. 2023 May;15(5):1298-1303. doi: 10.1111/os.13724. Epub 2023 Apr 13.
OBJECTIVE
Considering the high risk of postoperative neurological complications for patients with thoracic spinal stenosis (TSS), intra-operative neurophysiological monitoring (IONM) has been used for detecting possible iatrogenic injury timely. However, the IONM waveforms are often unreliable. This article is designed to determine the test performance of somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) during surgical thoracic decompression in patients with TSS, and to investigate the risk factors associated with deteriorated neurologic function at immediate postoperation.
METHODS
Patients undergoing posterior spinal fusion from February 2009 to December 2020 were retrospectively reviewed. Patients were divided into the deteriorated neurologic function (DNF) group and the improved/intact neurological function (INF) group based on the postoperative neurological status. Demographic parameters such as gender, age, height, weight, etiology and IONM data were compared between groups. Demographics and IONM data between DNF and INF groups were compared by independent t or nonparametric tests. The incidence of abnormal SEP was analyzed by Chi-square test.
RESULTS
A total of 108 patients (63 males, 45 females) with an average age of 53.5 ± 14.0 years were included. The SEP and MEP records were available in 94 and 98 patients, with the overall success rates being 87.0% and 90.7%, respectively. The sensibilities and specificities were 100% and 88.2% for SEP, 100% and 98.8% for MEP, respectively. There were 17 patients in DNF group and 91 patients in INF group. High weight (79.1 ± 14.6 vs 69.7 ± 15.7 kg, P = 0.024), high inter-side difference of MEP amplitude (899.1 ± 997.5 vs 492.3 ± 512.4 μV, P = 0.013) and high incidence of abnormal SEP (94.1% vs 64.8%, P = 0.024) were observed in the DNF group. Fourteen (82.4%) patients in the DNF group showed improvement in neurological status during follow-up.
CONCLUSIONS
The overall success rates were 87.0% for SEP and 90.7% for MEP in patients with TSS.
目的
考虑到胸椎管狭窄症（TSS）患者术后发生神经并发症的风险较高，术中神经生理监测（IONM）已被用于及时检测可能的医源性损伤。然而，IONM 波形往往不可靠。本文旨在确定体感诱发电位（SEP）和运动诱发电位（MEP）在 TSS 患者手术减压过程中的检测性能，并探讨与术后即刻神经功能恶化相关的危险因素。
方法
回顾性分析 2009 年 2 月至 2020 年 12 月接受后路脊柱融合术的患者。根据术后神经功能状态，将患者分为神经功能恶化（DNF）组和神经功能改善/正常（INF）组。比较两组患者的性别、年龄、身高、体重、病因和 IONM 数据等一般资料。采用独立 t 检验或非参数检验比较 DNF 组和 INF 组之间的一般资料和 IONM 数据。采用卡方检验分析 SEP 异常的发生率。
结果
共纳入 108 例患者（63 例男性，45 例女性），平均年龄为 53.5±14.0 岁。94 例患者 SEP 和 MEP 记录可用，总体成功率分别为 87.0%和 90.7%。SEP 的灵敏度和特异度分别为 100%和 88.2%，MEP 分别为 100%和 98.8%。DNF 组 17 例，INF 组 91 例。DNF 组体重较高（79.1±14.6 与 69.7±15.7kg，P=0.024）、MEP 振幅两侧间差异较大（899.1±997.5 与 492.3±512.4μV，P=0.013）、SEP 异常发生率较高（94.1%与 64.8%，P=0.024）。DNF 组 14 例（82.4%）患者在随访期间神经功能状态改善。
结论
TSS 患者 SEP 和 MEP 的总体成功率分别为 87.0%和 90.7%。
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