Transcranial MEPs predict clinical outcome during minimally invasive dorsal decompression for cervical spondylotic myelopathy

IF 2.7 4区医学 Q2 CLINICAL NEUROLOGY

Neurophysiologie Clinique/Clinical Neurophysiology Pub Date : 2024-11-01 DOI:10.1016/j.neucli.2024.103022

Fares Komboz , Fabian Kück , Silvia Hernández-Durán , Ingo Fiss , Xenia Hautmann , Dorothee Mielke (Prof.) , Veit Rohde (Prof.) , Tammam Abboud

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引用次数: 0

Abstract

Objectives

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.

Methods

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).

Results

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.

Conclusion

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.

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经颅 MEP 预测微创背侧减压术治疗颈椎病的临床效果

目的运动诱发电位（MEP）监测是实时评估皮质脊髓束完整性的可靠方法。然而，在脊柱退行性手术期间进行 MEP 监测的潜在益处仍存在争议。本研究旨在确定颈椎脊髓病（CSM）手术期间的 MEP 监测在预测预后方面的作用。方法在治疗 CSM 的背侧减压术中进行经颅电刺激以诱发 MEP。在手术开始和结束时分别评估减压部位水平/远端神经根对应的上肢肌肉的MEP阈值水平。临床结果采用改良日本骨科协会评分（mJOA）进行测量。31名患者（66%）出院时神经功能有所改善。特定患者大部分测试肌肉或至少一个肌群的明显改善与出院时 mJOA 评分的增加高度相关（p < 0.001），几率比分别为 10.3 (CI:2.6-34.4) 和 11.4 (CI:2.8-41.3)。结论 CSM 手术期间 MEP 的改善似乎对术后早期神经功能恢复有很高的预测性，并可能表明亚临床信号传导增强。这凸显了 MEP 监测作为术中实时预测 CSM 患者减压后临床恢复的工具的潜力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurophysiologie Clinique/Clinical Neurophysiology 医学-临床神经学

CiteScore

5.20

自引率

3.30%

发文量

审稿时长

60 days

期刊介绍： Neurophysiologie Clinique / Clinical Neurophysiology (NCCN) is the official organ of the French Society of Clinical Neurophysiology (SNCLF). This journal is published 6 times a year, and is aimed at an international readership, with articles written in English. These can take the form of original research papers, comprehensive review articles, viewpoints, short communications, technical notes, editorials or letters to the Editor. The theme is the neurophysiological investigation of central or peripheral nervous system or muscle in healthy humans or patients. The journal focuses on key areas of clinical neurophysiology: electro- or magneto-encephalography, evoked potentials of all modalities, electroneuromyography, sleep, pain, posture, balance, motor control, autonomic nervous system, cognition, invasive and non-invasive neuromodulation, signal processing, bio-engineering, functional imaging.