Xu Bin, Xue Lijun, Jiang Minjian, Qin Daping, Gao Guodong, Zhang Hua
Clinical College of Traditional Chinese Medicine, Gansu University of Traditional Chinese Medicine No. 35 Dingxi East Road, Lanzhou 730000, Gansu, China.
Spine Surgery, Affiliated Hospital of Gansu University of Traditional Chinese Medicine No. 732 Jiayuguan West Road, Lanzhou 730020, Gansu, China.
Am J Transl Res. 2024 Jul 15;16(7):3026-3035. doi: 10.62347/DCLG9825. eCollection 2024.
To evaluate the predictive value of somatosensory evoked potentials (SEPs) for the efficacy of closed reduction combined with over-extension reduction technique (PVP) in managing thoracolumbar spinal compression fractures.
Data were collected from 125 patients who underwent closed reduction with PVP and SEP monitoring from February 2021 to July 2023. We evaluated surgery success rates, incidence of bone cement leakage, and patient recovery outcomes including vertebral anterior height, Oswestry Disability Index (ODI), and Cobb angle restoration. SEP results were analyzed to categorize patients into effective and ineffective treatment groups. Differences in SEP waveforms between these groups were examined, and ROC analysis was used to assess the predictive value of these differences. Multivariate logistic regression was employed to identify risk factors affecting treatment efficacy.
Post-treatment assessments showed significant improvements in vertebral anterior height, ODI, and Cobb angle. SEP monitoring correlated well with intraoperative findings and physical examinations. During reduction, changes in SEP latency and amplitude were noted in 37 patients, with 7 patients meeting SEP amplitude alarm criteria, which normalized after adjustments. During PVP, 28 patients exhibited SEP amplitude fluctuations and 5 experienced a 30% reduction in amplitude following initial cement injection, with no significant latency changes. Treatment was deemed effective in 93 patients and ineffective in 32. SEP amplitudes during vertebral compression and PVP were significantly lower in the effective group (P<0.05). The AUC for predicting treatment efficacy was 0.819 and 0.859, respectively. Multivariate analysis revealed low preoperative vertebral compression ratio, number of fractures, and abnormal SEP amplitudes as independent risk factors for treatment outcomes.
SEP monitoring provides an accurate reflection of spinal cord function during closed reduction with PVP, aiding in predicting treatment safety and efficacy. The use of SEP monitoring is thus recommended for clinical application in this context.
评估体感诱发电位（SEPs）对闭合复位联合过伸复位技术（PVP）治疗胸腰椎压缩性骨折疗效的预测价值。
收集2021年2月至2023年7月期间接受PVP闭合复位及SEP监测的125例患者的数据。我们评估了手术成功率、骨水泥渗漏发生率以及患者的恢复结果，包括椎体前缘高度、Oswestry功能障碍指数（ODI）和Cobb角恢复情况。分析SEP结果，将患者分为治疗有效组和无效组。检查两组之间SEP波形的差异，并采用ROC分析评估这些差异的预测价值。采用多因素逻辑回归确定影响治疗效果的危险因素。
治疗后评估显示椎体前缘高度、ODI和Cobb角有显著改善。SEP监测与术中发现及体格检查相关性良好。复位过程中，37例患者出现SEP潜伏期和波幅变化，7例患者符合SEP波幅报警标准，调整后恢复正常。在PVP过程中，28例患者出现SEP波幅波动，5例患者在初次注入骨水泥后波幅降低30%，潜伏期无明显变化。93例患者治疗有效，32例无效。有效组椎体压缩和PVP过程中的SEP波幅显著低于无效组（P<0.05）。预测治疗效果的AUC分别为0.819和0.859。多因素分析显示术前椎体压缩率低、骨折数量和SEP波幅异常是治疗结果的独立危险因素。
SEP监测可准确反映PVP闭合复位过程中的脊髓功能，有助于预测治疗安全性和疗效。因此，建议在这种情况下将SEP监测应用于临床。
