脊髓型颈椎病术中CSEP异常变化与手术相关因素分析

Veracity of cortical somatosensory evoked potential monitoring and influencing factors in operation for cervical spondylitic myelopathy

目的探讨皮层体感诱发电位(CSEP)在脊髓型颈椎病(CSM)术中监护的准确性以及与手术操作有关的影响因素。方法通过68例CSM手术中尺神经的CSEP监测,记录术中各个时期、各种手术操作对CSEP的影响及程度,以及术后脊髓功能情况进行分析和评定。结果68例全部获得CSEP成功监护,因各种手术操作引起CSEP预警的共24例44次,其中一般预警31次,经观察均能自动复原;危险预警11次,需暂停手术找原因,在纠正原因后亦能立即复原,本组术后无1例发生颈髓损害加重,也未见CSEP假阴性。结论CSEP能即时敏感、准确地监测脊髓感觉神经传导功能,并证明引起CSEP预警的主要手术操作因素包括:颈椎过伸或过屈体位、过度撑开椎间隙、前路椎管内彻底减压的手术操作以及置入植骨块过宽或过深等。

Objective To investigate the veracity of cortical somatosensory evoked potential （CSEP） and the influencing factors of manipulation of CSEP monitoring during the operation for cervical spondylitic myelopathy （CSM）. Methods Sixty-eight CSM patients, 45 males and 23 females, aged 52. 3, underwent CSEP monitoring at the ulnar, median, and posterior tibial nerves. The impact and level to CSEP of different period and manipulation during operation were recorded. The spinal cord function of postoperation were analyzed and evaluated. Results The CSEP monitoring was successful in all cases. CSEP prewarning appeared 44 times in 24 cases. Among them 31 times of common prewarning of CSEP were recorded because of operative manipulations and all of the 31 times of common prewarning recovered after careful manipulation. Dangerous prewarning was recorded for 11 times, and then the operation had to be stopped to search for the causes and awaken test was needed in one case. When the agents causing dangerous prewarning of CSEP were found and corrected, the CSEP was able to recover. Not a patient showed aggravation of nervous function damage and no false negative result was found. Conclusion CSEP can monitor the spinal cord function immediately and exactly. The main factors of operative manipulation causing prewarning of CSEP include overextension and overflexion, overbracing the space, operative manipulations for spinal cord thorough decompression, and overdeepening of graft.