Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea.
Department of Physical Medicine and Rehabilitation, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, South Korea.
Spine J. 2024 Jan;24(1):87-93. doi: 10.1016/j.spinee.2023.09.006. Epub 2023 Sep 11.
Decompression surgery is a treatment option for patients with degenerative cervical myelopathy (DCM). Surgical decisions primarily depend on clinical symptoms and radiological examinations. The diagnostic and prognostic significance of evoked potential tests for surgical outcomes in patients with DCM has not been thoroughly examined.
To identify the diagnostic and prognostic significance of preoperative evoked potential tests in patients with DCM who underwent decompression surgery.
This was a retrospective observational study.
One hundred two consecutive patients who underwent evoked potential tests and surgical treatment between January 2016 and December 2020 in a single spine center and had a minimum follow-up of 6 months.
Japanese Orthopedic Association (JOA) scores obtained preoperatively and 6 months after surgery.
This study evaluated the preoperative central motor conduction time (CMCT), somatosensory evoked potentials, and Japanese Orthopedic Association (JOA) scores obtained preoperatively and 6 months after surgery.
Abnormal CMCT findings were observed in 94 patients (92.2%). Abnormal somatosensory evoked potentials were observed in 77 patients (75.5%). There was a statistically significant correlation between preoperative JOA score and abductor pollicis brevis (APB)-CMCT (r=-0.546, p=.001), tibialis anterior (TA)-CMCT (r=-0.517, p<.001), median nerve (MN)-SSEP (r=-0.353, p=.001), and tibial nerve (TN)-SSEP (r=-0.349, p=.003). There were significant differences in recovery rates associated with diabetes mellitus (DM), preoperative severity of myelopathy, TA-CMCT, MN-SSEP, and TN-SSEP. Stepwise multiple regression analysis showed that the major factors affecting the clinical outcomes were TN-SSEP (β=0.327, p=.004), preoperative JOA score (β=0.278, p=.012), and DM (β=0.241, p=.025).
Evoked potential testing is a functional diagnostic tool that can indicate the severity of myelopathic symptoms in patients with DCM. Additionally, preoperative TN-SSEP may have significant prognostic value in predicting postoperative clinical outcomes. Thus, preoperative evoked potential tests could be helpful for determining suitable surgical treatment candidates and forecasting postoperative prognosis.
减压手术是治疗退行性颈椎病（DCM）患者的一种选择。手术决策主要取决于临床症状和影像学检查。对于接受减压手术的 DCM 患者，诱发电位检查在手术结果中的诊断和预后意义尚未得到彻底研究。
确定接受减压手术的 DCM 患者术前诱发电位检查的诊断和预后意义。
这是一项回顾性观察研究。
2016 年 1 月至 2020 年 12 月在单一脊柱中心接受诱发电位检查和手术治疗的 102 例连续患者，且至少随访 6 个月。
术前和术后 6 个月的日本矫形协会（JOA）评分。
本研究评估了术前正中运动传导时间（CMCT）、体感诱发电位和术前和术后 6 个月的日本矫形协会（JOA）评分。
94 例患者（92.2%）存在异常 CMCT 发现。77 例患者（75.5%）存在异常体感诱发电位。术前 JOA 评分与拇短展肌（APB）-CMCT（r=-0.546，p=.001）、胫骨前肌（TA）-CMCT（r=-0.517，p<.001）、正中神经（MN）-SSEP（r=-0.353，p=.001）和胫神经（TN）-SSEP（r=-0.349，p=.003）之间存在统计学显著相关性。糖尿病（DM）、术前脊髓病严重程度、TA-CMCT、MN-SSEP 和 TN-SSEP 与恢复率存在显著差异。逐步多元回归分析显示，影响临床结果的主要因素是 TN-SSEP（β=0.327，p=.004）、术前 JOA 评分（β=0.278，p=.012）和 DM（β=0.241，p=.025）。
诱发电位检查是一种功能诊断工具，可提示 DCM 患者脊髓病症状的严重程度。此外，术前 TN-SSEP 可能对预测术后临床结果具有重要的预后价值。因此，术前诱发电位检查有助于确定合适的手术治疗候选者并预测术后预后。
