多模式神经电生理监测在颈椎前路手术中的应用

Multimodal intraoperative monitoring （MIOM） during surgical procedures of anterior cervical spine

目的探讨多模式神经电生理监测（MIOM）在颈前路手术中的应用价值。方法53例颈椎前路手术患者采用术中MIOM监测，记录术中各个阶段的报警情况，并采取相应措施，使术中脊髓神经损伤的可能性最小化。分析术中警报按类型、原因、术前诊断以及手术方式之间的关系，通过神经电生理监测结果以及手术前后JOA评分对手术疗效进行分析。结果与术前基准电位相比较，术毕SEP及MEP波幅均有所提高，而潜伏期均未有明显改变。术后JOA评分较术前有明显改善（P〈0．05）。脊髓型颈椎病患者以及行椎体次全切手术者术中监测“严重警报”发生率较高。结论颈前路手术中多模式神经电生理监测能有效降低术中神经功能损伤，降低手术风险并能作为手术疗效评价以及神经功能恢复情况的客观依据。

Objective To evaluate the effectiveness of multimodal intraoperative monitoring （MIOM） during the surgical procedures of cervical spine. Methods A total of 53 consecutive patients who underwent anterior cervical spine surgery were monitored by MIOM during the surgical procedure. The complete medical records including the type of alert, preoperative diagnosis and surgical procedure were retrospectively reviewed, and the changes of neurophysiological monitoring record were compared with postoperative clinical improvement. Results Postoperative amplitudes of SEP and MEP and the JOA score were improved significantly（ P 〈 0.05 ）. The patients with cervical spondylotic myelopathy and those who accepted cervical corpectomy have the high risk of intraoperative alert. Conclusions MIOM is an effective method for monitoring the spinal cord functional integrity during cervical spine surgery and can help to reduce the risk of neurological deficit and it can also evaluate the nostonerative neurological imnrovement.