多模式神经电生理监测在颈椎前路手术中的预警意义

Application and significance of multimodal intraoperative neurophysiologic monitoring in anterior cervical spine surgery

中文关键词:  颈椎病  神经电生理监测  手术  脊髓神经功能

英文关键词:Cervical spine surgery  Neurophysiologic monitoring  Operation  Spinal cord function

中文摘要:

  【摘要】 目的：探讨多模式神经电生理监测在颈椎前路手术中的预警意义。方法：2014年9月~2015年4月对53例行颈椎前路手术的颈椎病患者术中进行多模式神经电生理监测（A组），选取60例年龄、性别、病变节段和手术方式匹配但未进行神经电生理监测的颈椎前路手术患者作为对照（B组）。比较两组患者手术时间、术中出血量、神经根型颈椎病患者手术前后颈痛及上肢疼痛视觉模拟评分法（visual analogue scales，VAS）评分、颈部功能障碍指数（neck disability index，NDI）、脊髓型颈椎病患者术后JOA评分改善率和并发症的发生情况，分析A组病例中术中预警的类型和原因，以及与术前诊断、手术方式和手术节段之间的关系。结果：A组患者的手术时间为1.3±0.5h（0.8~2.1h），术中出血量为390±236ml（120~600ml），B组患者的手术时间为1.2±0.7h（0.6~2.4h），术中出血量为346±293ml（105~610ml），两组比较均无统计学差异（P>0.05）。A、B两组神经根型颈椎病患者术前、术后的颈部和上肢VAS评分均无显著性差异（6.5±1.6 vs. 6.8±1.4，7.6±2.4 vs. 7.4±2.7, 3.8±1.2 vs. 3.6±1.6，3.3±1.4 vs. 3.9±1.8，P>0.05），A组神经根型颈椎病患者术后NDI和脊髓型颈椎病患者JOA评分改善率明显优于B组[（19.2±7.1 vs 22.1±5.6，（84.1±10.3）% vs （73.3±9.2）%；P<0.05]。在A组病例中，颈椎前路椎体次全切椎间融合手术较颈前路椎间盘切除椎间融合术的术中监测“严重预警”发生率更高（P<0.05），但两种手术方式的“次要预警”发生率无显著性差异（P>0.05）；脊髓型颈椎病与神经根型颈椎病之间、单节段手术与双节段手术之间的术中监测“严重预警”和“次要预警”发生率均无统计学差异（P>0.05）。结论：多模式神经电生理监测在颈椎前路手术中能及时预警神经损伤，可有效提高手术的安全性和临床疗效。

英文摘要:

  【Abstract】 Objectives: To explore the application and significance of multimodal intraoperative neurophysiologic monitoring(MIOM) in anterior cervical spine surgery. Methods: From September 2014 to April 2015，fifty-three patients undergoing anterior cervical spine surgery with MIOM(group A) were analyzed, and 60 patients matched by age, gender, diagnosis, surgical levels and surgical treatment options without intraoperative neurophysiologic monitoring(group B), served as control group. The clinical outcomes and complications between two groups, including operation time, blood loss, visual analogue scales(VAS) of neck pain and arm radiating pain, neck disability index(NDI) and JOA were compared. The relationships between the type of alert and preoperative diagnosis, surgical levels and procedure were analyzed. Results: In group A, the mean operation time was 1.3±0.5h(0.8-2.1h), and the mean blood loss was 390±236ml(120-600ml); in group B, the mean operation time was 1.2±0.7h(0.6-2.4h), and the mean blood loss was 346±293ml(105-610ml). No difference in the average operation time or blood loss was observed in two groups(P>0.05), as well as no difference in VAS for arm and neck pain in two groups(6.5±1.6 vs. 6.8±1.4, 7.6±2.4 vs. 7.4±2.7, 3.8±1.2 vs. 3.6±1.6, 3.3±1.4 vs. 3.9±1.8, P>0.05). Group A had a lower average neck disability index(NDI) than that of group B(19.2±7.1 vs. 22.1±5.6, P<0.05); group A had a higher average JOA improvement rate than that of group B[(84.1±10.3)% vs. (73.3±9.2)%, P<0.05]. In group A, the patients who accepted anterior cervical corpectomy fusion had higher risk of intraoperative major alerts than the patients who accepted anterior cervical discectomy and fusion(P<0.05). However, there were no statistically significant differences in intraoperative major and minor alerts when comparing the patients with cervical spondylotic radiculopathy with the patients with cervical spondylotic myelopathy, and the patients with single-level cervical fusion with the patients with two-level cervical fusion(P>0.05). Conclusions: MIOM is an effective and reliable method for monitoring the spinal cord function during anterior cervical spine surgery, which can reduce the risk of neurological deficit and improve surgical outcome．