胸椎非肿瘤手术中术中神经监测的诊断准确性:一项系统回顾和荟萃分析

IF 1.8 4区 医学 Q3 CLINICAL NEUROLOGY
Raja Narendra Divakar Addanki , Priti Ezhuvathra , Abdullah M. Al-Qudah , Benjamin B. Lee , Katherine M. Anetakis , Jeffrey R. Balzer , Parthasarathy D. Thirumala
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引用次数: 0

摘要

背景胸椎手术由于椎管狭窄和血液供应不稳定,神经系统并发症的风险较高,因此有效的监测至关重要。本研究首次荟萃分析评估了术中神经监测(IONM)在非肿瘤胸椎手术中的准确性和预后价值,填补了文献中的一个关键空白。方法我们遵循PRISMA-DTA指南,在PubMed检索相关研究。纳入的研究有超过10例患者,并排除脊髓肿瘤。采用QUADAS-2评价研究质量。使用双变量模型计算诊断指标,敏感性,特异性和曲线下面积。IONM方法的比较采用z检验和贝叶斯元分析。还进行了异质性评估以确保稳健性。结果在19项研究的3261例病例中,9.3%的病例出现了术后新的神经功能缺损。与体感诱发电位(65.5%,93.0%)和经颅运动诱发电位(79.7%,92.1%)相比,多模态IONM在检测这些缺陷方面优于其他方法,达到82.0%的灵敏度(95% CI: 66.7-91.2)和94.7%的特异性(95% CI: 88.4-97.6)。其曲线下面积达94.5%,准确度较高。值得注意的是,恢复的IONM警报与较低的术后缺陷率相关(10.7 - 13.8%)。结论结合SSEP和TcMEP的多模态IONM在胸椎手术神经损伤的检测和预防方面优于单一模态IONM。警报后立即干预,通过恢复警报的低缺陷率证明,使其成为最佳策略。在这种高风险的手术环境中,将这些见解纳入临床方案可以提高患者的安全性和预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Diagnostic accuracy of intraoperative neuromonitoring during non-tumor thoracic spine surgeries: A systematic review and meta-analysis

Background

Thoracic spine surgeries carry a higher risk of neurological complications due to the region’s narrow spinal canal and precarious blood supply, making effective monitoring critical. This study offers the first meta-analysis assessing accuracy and prognostic value of Intraoperative neuromonitoring (IONM) in non-tumor thoracic spinal surgeries, filling a key gap in the literature.

Methods

We adhered to PRISMA-DTA guidelines, conducting a PubMed search for relevant studies. Included studies had over 10 patients and excluded spinal cord tumors. Study quality was evaluated with QUADAS-2. Diagnostic metrics, sensitivity, specificity, and area under the curve, were calculated using a bivariate model. Comparisons between IONM methods utilized Z-tests and Bayesian meta-analysis. Heterogeneity assessments were also performed to ensure robustness.

Results

Across 19 studies with 3,261 cases, postoperative new neurological deficits occurred in 9.3 % of cases. Multimodal IONM outperformed other methods in detecting these deficits, achieving 82.0 % sensitivity (95 % CI: 66.7–91.2) and 94.7 % specificity (95 % CI: 88.4–97.6), compared to somatosensory evoked potentials (65.5 %, 93.0 %) and transcranial motor evoked potentials (79.7 %, 92.1 %). Its area under the curve reached 94.5 %, highlighting excellent accuracy. Notably, recovered IONM alerts correlated with a less rate of postoperative deficits (10.7–13.8 %).

Conclusion

Multimodal IONM, combining SSEP and TcMEP, surpasses single modalities in detecting and preventing neurological damage in thoracic spine surgeries. Immediate intervention after alerts, evidenced by low deficit rates with recovered alerts, makes it the optimal strategy. Adopting these insights into clinical protocols enhances patient safety and outcomes in this high-risk surgical context.
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来源期刊
Journal of Clinical Neuroscience
Journal of Clinical Neuroscience 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
402
审稿时长
40 days
期刊介绍: This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.
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