术前运动状态对胸椎手术中经颅运动诱发电位警报阳性预测值的影响：日本脊柱外科学会及相关研究监测委员会的一项前瞻性多中心研究
Impact of Preoperative Motor Status for the Positive Predictive Value of Transcranial Motor-Evoked Potentials Alerts in Thoracic Spine Surgery: A Prospective Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.
作者信息
Funaba Masahiro, Kanchiku Tsukasa, Yoshida Go, Machino Masaaki, Ushirozako Hiroki, Kawabata Shigenori, Ando Muneharu, Yamada Kei, Iwasaki Hiroshi, Shigematsu Hideki, Fujiwara Yasushi, Tadokoro Nobuaki, Takahashi Masahito, Taniguchi Shinichirou, Wada Kanichiro, Yamamoto Naoya, Yasuda Akimasa, Morito Shinji, Hashimoto Jun, Takatani Tsunenori, Kobayashi Kazuyoshi, Ando Kei, Kurosu Kenta, Segi Naoki, Nakashima Hiroaki, Nakanishi Kazuyoshi, Takeshita Katsushi, Matsuyama Yukihiro, Imagama Shiro
机构信息
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
Department of Orthopedic Surgery, Yamaguchi Rosai Hospital, Yamaguchi, Japan.
出版信息
Global Spine J. 2025 Mar;15(2):506-517. doi: 10.1177/21925682231196454. Epub 2023 Aug 22.
STUDY DESIGN
Prospective multicenter study.
OBJECTIVE
To investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in thoracic spine surgery and evaluate the impact of specific factors associated with positive predictive value (PPV).
METHODS
One thousand hundred and fifty-six cases of thoracic spine surgeries were examined by comparing patient backgrounds, disease type, preoperative motor status, and Tc-MEP alert timing. Tc-MEP alerts were defined as an amplitude decrease of more than 70% from the baseline waveform. Factors were compared according to preoperative motor status and the result of Tc-MEP alerts. Factors that showed significant differences were identified by univariate and multivariate analysis.
RESULTS
Overall sensitivity was 91.9% and specificity was 88.4%. The PPV was significantly higher in the preoperative motor deficits group than in the preoperative no-motor deficits group for both high-risk (60.3% vs 38.3%) and non-high-risk surgery groups (35.1% vs 12.8%). In multivariate logistic analysis, the significant factors associated with true positive were surgical maneuvers related to ossification of the posterior longitudinal ligament (odds ratio = 11.88; 95% CI: 3.17-44.55), resection of intradural intramedullary spinal cord tumor (odds ratio = 8.83; 95% CI: 2.89-27), preoperative motor deficit (odds ratio = 3.46; 95% CI: 1.64-7.3) and resection of intradural extramedullary spinal cord tumor (odds ratio = 3.0; 95% CI: 1.16-7.8). The significant factor associated with false positive was non-attributable alerts (odds ratio = .28; 95% CI: .09-.85).
CONCLUSION
Surgeons are strongly encouraged to use Tc-MEP in patients with preoperative motor deficits, regardless of whether they are undergoing high-risk spine surgery or not. Knowledge of PPV characteristics will greatly assist in effective Tc-MEP enforcement and minimize neurological complications with appropriate interventions.
研究设计
前瞻性多中心研究。
目的
探讨经颅运动诱发电位（Tc-MEP）在胸椎手术中的有效性，并评估与阳性预测值（PPV）相关的特定因素的影响。
方法
通过比较患者背景、疾病类型、术前运动状态和Tc-MEP警报时机，对1156例胸椎手术病例进行检查。Tc-MEP警报定义为与基线波形相比幅度下降超过70%。根据术前运动状态和Tc-MEP警报结果对因素进行比较。通过单因素和多因素分析确定显示出显著差异的因素。
结果
总体敏感性为91.9%，特异性为88.4%。在高风险（60.3%对38.3%）和非高风险手术组中，术前运动功能缺损组的PPV均显著高于术前无运动功能缺损组（35.1%对12.8%）。在多因素逻辑分析中，与真阳性相关的显著因素是与后纵韧带骨化相关的手术操作（比值比=11.88；95%置信区间：3.17-44.55）、硬脊膜内髓内脊髓肿瘤切除术（比值比=8.83；95%置信区间：2.89-27）、术前运动功能缺损（比值比=3.46；95%置信区间：1.64-7.3）和硬脊膜内髓外脊髓肿瘤切除术（比值比=3.0；95%置信区间：1.16-7.8）。与假阳性相关的显著因素是非归因性警报（比值比=0.28；95%置信区间：0.09-0.85）。
结论
强烈鼓励外科医生在术前有运动功能缺损的患者中使用Tc-MEP，无论他们是否正在接受高风险脊柱手术。了解PPV特征将极大地有助于有效实施Tc-MEP，并通过适当干预将神经并发症降至最低。
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