多模式神经电生理监测技术在颈前路手术摆体位过程中的作用

Role of multimodal intraoperative neurophysiological monitoring during positioning of anterior cervical spine surgery

目的探讨多模式神经电生理监测(MIOM)技术在颈前路手术摆体位过程中的作用。方法回顾性分析2016年9月至2018年7月在MIOM辅助下颈前路手术治疗的55例病人的临床资料。采用日本骨科协会(JOA)评分评估疗效。观察颈椎体位摆放过程中,经颅运动诱发电位(TcMEP)、体感诱发电位(SSEP)变化。结果在体位摆放过程中,6例TcMEP部分消失、SSEP未见明显变化,其中5例在颈部重新摆放体位后,TcMEP完全恢复、SSEP未见明显变化;1例在颈部复位后,TcMEP并没有立即完全恢复,而是在减压后完全恢复,SSEP未见明显变化。术毕TcMEP波幅较术前均有提高,而TcMEP潜伏期及SSEP均未见明显变化。所有病人术后均未出现新的神经功能障碍。55例术后7 d JOA评分[(13.53±1.93)分]较术前[(10.25±2.80)分]显著提高(P<0.05)。结论 MIOM技术是预防颈前路手术体位摆放过程中颈髓、神经根损伤的有效方法,其中TcMEP对颈部体位摆放相关颈髓及神经根损伤的敏感性较高,颈部复位可纠正不当体位,避免或加重颈髓或神经的损伤。

Objective To explore the role of multimodal intraoperative neuroelectrophysiological monitoring(MINM) during the positioning of anterior cervical spine surgery(ACSS). Methods The clinical data of 55 patients undergoing ACSS under MINM in our department from September, 2016 to July, 2018 were analyzed retrospectively, including MINM data of 55 patients from the beginning of positioning to the end of the surgical procedure, demographic, images and preoperative and postoperative electrophysiological data and Japanese Orthpaedic Association(JOA) score. Results MINM warnings appeared in 6 patients during the positioning. The transcrainial motor evoked patential(TcMEP) disappeared and the somatosensory evoked potentials(SSEP) did not change significantly in 6 patients,of whom, 5 had complete recovery of TcMEP and 1 who did not had complete recovery of TcMEP after neck repositioning. The amplitudes of TcMEP were improved significantly after the operation in all the patients, in whom new neurological dysfunction was not found after the operation. The JOA scores were improved significantly 7 days after the surgery compared with those before the surgery in all the patients(P<0.05). Conclusions MINM is an efficient method to prevent the injury of cervical spinal cord and nerve root during the positioning during ACSS. TcMEP shows higher sensitivity to cervical spine injury related to the positioning. Neck reposition is very helpful to restoring the electrophysiological signals by correcing the improper position of the neck and the sequelae are effectively prevented.