椎板成形术中术中诱发电位的局限性和实用性。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Rossella Rispoli, Christian Lettieri, Giada Pauletto, Gabriele Valiante, Yan Tereshko, Barbara Cappelletto
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引用次数: 0

摘要

背景:在过去的10年里,术中神经生理监测(IONM)在治疗脊髓型颈椎病的手术中得到了广泛的应用。我们的研究考虑了IONM在椎板成形术中的预测价值,首先考虑了脊髓减压的充分性,其次考虑了长期的神经功能结果。方法:我们考虑了38例诊断为退行性颈椎病并行开门椎板成形术的患者。所有患者术前、术后3个月和12个月采用日本骨科协会(JOA)评分进行评估。术前和术中分别记录上肢和下肢体感和运动诱发电位(ssep和MEPs)。结果:手术期间,38例患者中有3例ssep和mep较基线值恶化。手术随后由椎板成形术转为椎板切除术,导致诱发电位逐渐恢复。与较好的临床结果显著相关的神经生理参数是下肢mep的潜伏期。在手术结束时MEPs潜伏期明显减少的12例患者显示出更高的术后JOA评分,与3个月和12个月随访时的基线值相比增加≥30%。结论:虽然IONM不是临床结果的预测因子,但对于评估脊髓减压的有效性至关重要。下肢mep潜伏期的减少可能预示着更好的临床结果。我们建议对退行性颈椎病患者进行IONM检查。有必要进行更大规模的研究来阐明IONM的预测价值。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Limits and usefulness of intraoperative evoked potentials during laminoplasty.

Background: Over the past 10 years, intraoperative neurophysiological monitoring (IONM) has been widely performed during surgery for treating spondylotic cervical myelopathy. Our study considers the predictive value of IONM during laminoplasty, regarding, first, the adequacy of spinal cord decompression and, second, the long-term neuro-functional outcome.

Methods: We considered 38 patients with the diagnosis of degenerative cervical myelopathy who underwent an open-door laminoplasty. All patients were evaluated preoperatively, and at three and 12 months postoperatively, with the Japanese Orthopedic Association (JOA) point scale. Upper and lower limb somatosensory and motor evoked potentials (SSEPs and MEPs) were recorded preoperatively and intraoperatively.

Results: During surgery, three of 38 patients showed a deterioration of SSEPs and MEPs compared to baseline values. Surgery was then converted from laminoplasty to laminectomy, resulting in the gradual restoration of the evoked potentials. The neurophysiological parameter significantly associated with a better clinical outcome was the latency of lower limbs MEPs. The 12 patients who had a more prominent reduction of the MEPs latency at the end of surgery showed a higher post-surgical JOA score, increasing ≥30% compared to baseline values at the 3- and 12-month follow-up.

Conclusions: Though not a predictor of clinical outcome, the IONM was essential to evaluate the effectiveness of spinal cord decompression. Reduced latency of lower limbs MEPs may predict a better clinical outcome. We suggest that IONM in patients with degenerative cervical myelopathy should be routine. It is necessary to conduct larger studies to clarify the predictive value of IONM.

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来源期刊
Journal of neurosurgical sciences
Journal of neurosurgical sciences CLINICAL NEUROLOGY-SURGERY
CiteScore
3.00
自引率
5.30%
发文量
202
审稿时长
>12 weeks
期刊介绍: The Journal of Neurosurgical Sciences publishes scientific papers on neurosurgery and related subjects (electroencephalography, neurophysiology, neurochemistry, neuropathology, stereotaxy, neuroanatomy, neuroradiology, etc.). Manuscripts may be submitted in the form of ditorials, original articles, review articles, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work.
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