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多通道体感诱发电位记录在脊柱侧凸矫正手术患者中的价值。

Value of multi-channel somatosensory evoked potentials recording in patients undergoing scoliosis correction surgery.

机构信息

Department of Functional Examination, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, China.

Spine Hospital, Honghui Hospital, Xi'an Jiaotong University, Xi'an, 710000, China.

出版信息

Eur Spine J. 2023 Nov;32(11):4045-4053. doi: 10.1007/s00586-023-07899-8. Epub 2023 Aug 29.

Abstract

PURPOSE

We aimed to investigate the value of intraoperative multi-channel recording of somatosensory evoked potentials (SSEPs) in patients undergoing posterior instrumentation surgery with fusion.

METHODS

This study included 176 patients with scoliosis who underwent posterior correction surgery from January 2019 to June 2020. Among them, 88 patients underwent routine SSEPs monitoring via single-channel (Cz'-Fpz) cortical recording (control group), while the remaining 88 patients underwent multi-channel (Cz'-Fpz and C3'-C4') SSEPs monitoring in the cortex. Chi-square and Fisher's exact tests were used to analyze the influence of age, spinal deformity classification, and Cobb angle on waveform differentiation and the success rate of SSEPs monitoring.

RESULTS

Univariate analysis revealed that age, type of scoliosis, and Cobb angle exerted significant effects on the success rate of intraoperative SSEPs monitoring, and the SSEPs waveform differentiation rate was poorest among patients with congenital scoliosis. Intraoperative monitoring results indicated that the success rate of single-channel SSEPs monitoring was 90.9%, while that of multi-channel monitoring was 98.9% (P < 0.05). Among the intraoperative alarm cases, the incidence of adverse events after single-channel SSEPs monitoring was 66.7%, while the incidence of adverse events after multi-channel SSEPs monitoring was only 28.6%.

CONCLUSION

Multi-channel cortical SSEPs monitoring can effectively and accurately evaluate the function of the posterior column of the spinal cord. Use of multi-channel SSEP monitoring may help to improve the success rate of monitoring and reduce the incidence of postoperative adverse events in patients with congenital scoliosis.

摘要

目的

本研究旨在探讨后路内固定融合手术中多导体感诱发电位(SSEP)监测的价值。

方法

本研究纳入 2019 年 1 月至 2020 年 6 月期间 176 例接受后路矫形手术的脊柱侧凸患者。其中 88 例行常规单通道(Cz'-Fpz)皮质记录(对照组)SSEP 监测,88 例行多通道(Cz'-Fpz 和 C3'-C4')皮质 SSEP 监测。采用卡方检验和 Fisher 确切概率法分析年龄、脊柱畸形分类和 Cobb 角对波形分化和 SSEP 监测成功率的影响。

结果

单因素分析显示,年龄、脊柱侧凸类型和 Cobb 角对术中 SSEP 监测成功率有显著影响,先天性脊柱侧凸患者的 SSEP 波形分化率最差。术中监测结果显示,单通道 SSEP 监测成功率为 90.9%,多通道监测成功率为 98.9%(P<0.05)。在术中报警病例中,单通道 SSEP 监测后不良事件发生率为 66.7%,多通道 SSEP 监测后不良事件发生率仅为 28.6%。

结论

多导皮质 SSEP 监测可有效、准确地评估脊髓后柱功能。多通道 SSEP 监测的应用可能有助于提高监测成功率,降低先天性脊柱侧凸患者术后不良事件的发生率。

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