Karan Rakic Vedrana, Djilvesi Djula, Cvjetkovic Nikoletic Djurdja, Lakic Tanja, Klasnja Jelena, Lukac Pualic Sonja, Karan Mladen
Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
Center for Radiology, University Clinical Center of Vojvodina, 21000 Novi Sad, Serbia.
J Clin Med. 2025 Apr 12;14(8):2647. doi: 10.3390/jcm14082647.
In this study, we used intraoperative neurophysiological monitoring (IONM) during anterior cervical discectomy and fusion (ACDF). Rather than emphasizing its use for safety purposes, our goal was to evaluate how neurophysiological parameters change during surgery and their correlation with clinical findings. This study included 30 patients who underwent ACDF. Detailed neurological examination was performed together with manual muscle testing (MMT), the Numeric Pain Rating Scale (NPRS), and the Neck Disability Index (NDI) questionnaire. During surgery, somatosensory-evoked potentials (SSEPs), motor-evoked potentials (MEPs), and spontaneous electromyography were registered. There were statistically significant difference in the latency and amplitude of SSEPs of the right median nerve. Regarding the left median nerve, there was a statistically significant difference in amplitude, but not in latency. Differences were also observed in the amplitudes of right and left tibial nerve SSEPs, though no significant differences were found in their latencies. No statistically significant difference was found in the threshold values required to elicit MEPs between the beginning and end of the surgery. Additionally, we found a statistically significant positive correlation between the latency of the left and right median nerve and the left tibial nerve with somatosensory impairment. There was also a significant negative correlation between the amplitude of both tibial nerves and somatosensory impairment, and their latency showed a significant negative correlation with pain level before surgery. We found statistically significant decreases in NDI and pain level values one month after surgery. The results show significant changes in SSEPs and a correlation between clinical and neurophysiological findings and emphasize the importance of using MEPs to assess the condition of the motor system. Additionally, there was a general improvement in the patients' condition, as assessed by NDI and pain scores. This study identifies critical surgical phases to consider in the absence of real-time neuromonitoring feedback and emphasizes that clinical observations may not fully reflect the condition of neurological structures in patients with myelopathy, which is crucial when deciding on timely surgery.
在本研究中，我们在前路颈椎间盘切除融合术（ACDF）期间使用了术中神经生理监测（IONM）。我们的目标不是强调其用于安全目的，而是评估神经生理参数在手术过程中的变化及其与临床发现的相关性。本研究纳入了30例行ACDF的患者。同时进行了详细的神经学检查，包括徒手肌力测试（MMT）、数字疼痛评分量表（NPRS）和颈部功能障碍指数（NDI）问卷。手术过程中，记录了体感诱发电位（SSEP）、运动诱发电位（MEP）和自发肌电图。右侧正中神经SSEP的潜伏期和波幅存在统计学显著差异。关于左侧正中神经，波幅存在统计学显著差异，但潜伏期无差异。右侧和左侧胫神经SSEP的波幅也观察到差异，但其潜伏期未发现显著差异。手术开始和结束时诱发MEP所需的阈值未发现统计学显著差异。此外，我们发现左侧和右侧正中神经以及左侧胫神经的潜伏期与感觉障碍之间存在统计学显著正相关。两条胫神经的波幅与感觉障碍之间也存在显著负相关，其潜伏期与术前疼痛水平呈显著负相关。我们发现术后1个月NDI和疼痛水平值有统计学显著下降。结果显示SSEP有显著变化，临床和神经生理发现之间存在相关性，并强调了使用MEP评估运动系统状况的重要性。此外，根据NDI和疼痛评分评估，患者的状况总体有所改善。本研究确定了在缺乏实时神经监测反馈时需要考虑的关键手术阶段，并强调临床观察可能无法完全反映脊髓病患者神经结构的状况，这在决定是否及时进行手术时至关重要。
