Department of Neurosurgery, University Medical Center Göttingen, Robert-Koch-Straße 40 37075 Göttingen, Germany.
Department of Medical Statistics, University Medical Center Göttingen, Robert-Koch-Straße 40 37075 Göttingen, Germany.
Neurophysiol Clin. 2024 Nov;54(6):103022. doi: 10.1016/j.neucli.2024.103022. Epub 2024 Nov 5.
Motor evoked potential (MEP) monitoring is a reliable method for real-time assessment of corticospinal tract integrity. However, the potential benefits of MEP monitoring during degenerative spine surgery remain controversial. This study aims to determine the role of MEP monitoring during surgery for cervical spondylotic myelopathy (CSM) in prediction of prognosis.
Transcranial electrical stimulation was performed to elicit MEPs during dorsal decompression for the treatment of CSM. MEP-threshold levels were assessed separately at the beginning and end of the surgery in upper extremity muscles corresponding to nerve roots at the level of/distal to the decompression site. Clinical outcome was measured using the modified Japanese Orthopedic Association score (mJOA).
The study included 47 patients. 31 patients (66 %) showed improvements in neurological function at discharge. A measurable improvement in the majority of tested muscles, or in at least one muscle group, in a given patient highly correlated with mJOA score increase at discharge (p < 0.001) with an odds ratio of 10.3 (CI:2.6-34.4) and 11.4 (CI:2.8-41.3), respectively. Conversely, MEP deterioration was not associated with worse clinical outcome, nor was it predictive of failure to recover.
MEP improvement during CSM surgery seems to be highly predictive of early postoperative neurological recovery and could indicate subclinically enhanced signal conduction. This highlights the potential of MEP monitoring as an intraoperative, real-time predictive tool for clinical recovery after decompression in patients with CSM.
运动诱发电位（MEP）监测是实时评估皮质脊髓束完整性的可靠方法。然而，MEP 监测在退行性脊柱手术中的潜在益处仍存在争议。本研究旨在确定 MEP 监测在治疗颈椎病性脊髓病（CSM）的后路减压术中对预后预测的作用。
采用经颅电刺激在治疗 CSM 的后路减压术中引出 MEP。在手术开始和结束时，分别评估与减压部位水平/远侧神经根相对应的上肢肌肉中的 MEP 阈值水平。使用改良日本矫形协会评分（mJOA）测量临床结果。
该研究纳入了 47 例患者。31 例（66%）患者在出院时神经功能改善。大多数测试肌肉或至少一组肌肉在特定患者中出现可测量的改善，与出院时 mJOA 评分的增加高度相关（p < 0.001），优势比分别为 10.3（95%CI：2.6-34.4）和 11.4（95%CI：2.8-41.3）。相反，MEP 恶化与临床结局恶化无关，也不能预测恢复失败。
CSM 手术中 MEP 的改善似乎高度预测术后早期神经恢复，并可能表明亚临床信号传导增强。这突出了 MEP 监测作为 CSM 患者减压术后临床恢复的术中实时预测工具的潜力。
