Owen J H, Sponseller P D, Szymanski J, Hurdle M
Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Spine (Phila Pa 1976). 1995 Jul 1;20(13):1480-8. doi: 10.1097/00007632-199507000-00007.
This study determined the relative efficacy of somatosensory-evoked potentials and motor-evoked potentials in monitoring spinal cord function during surgery for patients with idiopathic versus neuromuscular scoliosis.
To determine whether patients with idiopathic versus neuromuscular scoliosis demonstrate significantly different somatosensory-evoked potentials and motor-evoked potentials recorded during surgery.
Ashkenaze et al (1993) and others have reported that cortical somatosensory-evoked potentials are unreliable when used to monitor spinal cord function in patients with neuromuscular scoliosis. It was recommended that other neurophysiologic tests be used.
Somatosensory-evoked potentials and motor-evoked potentials were recorded from two groups of patients: those with idiopathic scoliosis and those with neuromuscular scoliosis. Somatosensory-evoked potentials were obtained before and during surgery. Motor-evoked potentials were obtained during surgery. Normal variability, as indicated from idiopathic scoliotic results, was compared with data obtained from patients with neuromuscular scoliosis. Motor-evoked potentials and somatosensory-evoked potentials were obtained sequentially during the duration of surgery.
Single-channel cortical somatosensory-evoked potentials demonstrated a 27% positive rate, which was consistent with results (28%) from Ashkenaze et al. The use of multiple recording sites for the somatosensory-evoked potentials and the addition of motor-evoked potential procedures indicated that a reliable response could be obtained in more than 96% of the patients. It also was found that cortical somatosensory-evoked potentials were more affected by anesthetic agents when recorded from patients with neuromuscular scoliosis compared with patients with idiopathic scoliosis.
Single-channel cortical somatosensory-evoked potentials demonstrated a high level of unreliability, which reduced their clinical effectiveness. However, by using multiple recording sites with the somatosensory-evoked potentials and by administering motor-evoked potential procedures, it was possible to monitor spinal cord function in neuromuscular patients and avoid postoperative neurologic deficits.
本研究确定了体感诱发电位和运动诱发电位在特发性与神经肌肉性脊柱侧弯患者手术期间监测脊髓功能方面的相对疗效。
确定特发性与神经肌肉性脊柱侧弯患者在手术期间记录的体感诱发电位和运动诱发电位是否存在显著差异。
阿什克纳齐等人（1993年）及其他研究者报告称，在神经肌肉性脊柱侧弯患者中用于监测脊髓功能时，皮质体感诱发电位不可靠。建议使用其他神经生理学测试。
从两组患者中记录体感诱发电位和运动诱发电位：特发性脊柱侧弯患者和神经肌肉性脊柱侧弯患者。在手术前和手术期间获取体感诱发电位。在手术期间获取运动诱发电位。将特发性脊柱侧弯结果所示的正常变异性与从神经肌肉性脊柱侧弯患者获得的数据进行比较。在手术过程中依次获取运动诱发电位和体感诱发电位。
单通道皮质体感诱发电位显示阳性率为27%，这与阿什克纳齐等人的结果（28%）一致。使用多个记录部位记录体感诱发电位并增加运动诱发电位程序表明，超过96%的患者能够获得可靠的反应。还发现，与特发性脊柱侧弯患者相比，从神经肌肉性脊柱侧弯患者记录皮质体感诱发电位时，其受麻醉剂的影响更大。
单通道皮质体感诱发电位显示出高度不可靠性，这降低了其临床有效性。然而，通过使用多个记录部位记录体感诱发电位并实施运动诱发电位程序，有可能监测神经肌肉患者的脊髓功能并避免术后神经功能缺损。
