Epstein N E, Danto J, Nardi D
Department of Surgery, North Shore University Hospital, Cornell Medical Center, Manhasset, New York.
Spine (Phila Pa 1976). 1993 May;18(6):737-47. doi: 10.1097/00007632-199305000-00011.
Continuous intraoperative somatosensory-evoked potential monitoring during scoliosis surgery, along with improved instrumentation techniques, has contributed to the reduction of neurologic injury from 4-6.9% to 0-0.7%. To assess whether somatosensory-evoked potential monitoring might play a similar role in cervical surgery, the authors compared the morbidity and mortality rates associated with 218 patients who were not monitored and were operated on between 1985-1989 with those found in 100 consecutive somatosensory-evoked potential monitored procedures done from 1989-1991. The cervical procedures were conducted for disc disease, stenosis, spondylosis, and ossification of the posterior longitudinal ligament. Eight of 218 unmonitored patients became quadriplegic (3.7%) and 1 died (0.5%); no instances of quadriplegia and no deaths were encountered among the 100 monitored patients. The reduction of neurologic deficit was attributed in part to early somatosensory-evoked potential detection of vascular or mechanical compromise of the spinal cord or nerve roots and to the immediate alteration of anesthetic or surgical technique in response to somatosensory-evoked potential changes, i.e., reversal of systemic or "relative" hypotension, adjustment of operative position, release of distraction, and cessation of manipulation. Continuous intraoperative somatosensory-evoked potential monitoring also was a practical tool in monitoring cervical surgery.
脊柱侧弯手术期间持续进行术中体感诱发电位监测，再加上改进的器械技术，已使神经损伤发生率从4% - 6.9%降至0% - 0.7%。为评估体感诱发电位监测在颈椎手术中是否可能发挥类似作用，作者比较了1985 - 1989年间未进行监测的218例接受手术患者与1989 - 1991年间连续100例接受体感诱发电位监测手术患者的发病率和死亡率。颈椎手术针对椎间盘疾病、狭窄、脊椎关节强硬和后纵韧带骨化进行。218例未监测患者中有8例发生四肢瘫痪（3.7%），1例死亡（0.5%）；100例监测患者中未出现四肢瘫痪病例，也无死亡情况。神经功能缺损的减少部分归因于体感诱发电位早期检测到脊髓或神经根的血管或机械性损伤，以及根据体感诱发电位变化立即改变麻醉或手术技术，即纠正全身或“相对性”低血压、调整手术体位、解除牵引和停止操作。术中持续体感诱发电位监测也是监测颈椎手术的一种实用工具。
