伴神经损害脊柱侧后凸畸形患者脊髓内移后路矫形术后神经电生理变化

Neurological outcomes of transvertebral transposition of the spinal cord and posterior correction in patients suffering from neurologic deficit secondary to angular kyphoscoliosis

中文关键词:  脊柱侧后凸畸形  脊髓内移术  神经电生理监测

英文关键词:Spinal kyphoscoliosis  Transvertebral transposition of the spinal cord  Intraoperative neurophysiologic monitoring

中文摘要:

  【摘要】 目的：观察伴神经功能损害脊柱侧后凸畸形患者脊髓内移后路矫形术后神经电生理变化和功能转归。方法：2005年1月~2014年1月在我院接受脊髓内移、脊柱后路矫形内固定术治疗伴神经损害的脊柱侧后凸畸形患者14例，女6例，男8例；年龄22.0±14.5岁（6~53岁）。术前均表现为双下肢麻木，其中7例伴行走不稳；双下肢病理征均为阳性。神经功能Frankel分级：C级5例，D级9例。胸弯11例，胸腰弯3例，后凸顶椎均位于侧凸顶椎区内。术前冠状面主弯Cobb角为76.9°±33.2°（65°~100°），后凸Cobb角为71.5°±31.8°（41°~125°）。采用加拿大XLTEK肌电诱发电位仪分别于术前和术后1周检测14例患者的体感诱发电位（SEP），术中行SEP和运动诱发电位（MEP）监测。在MRI上测量顶椎区凸侧脊髓外缘至椎管内缘距离，计算脊髓内移距离。结果：术前胫后神经SEP P40的波幅与峰潜伏期为1.67±0.38μV和38.96±2.51ms，术中为1.69±0.36μV和38.15±2.14ms，术中与术前比较波幅与峰潜伏期均无显著性变化（P>0.05）。术后冠状面主弯Cobb角矫正率为（50.3±20.6）%（14.5%~85%），后凸Cobb角矫正率为（39.0±17.7）%（20.8%~57.9%）；顶椎区脊髓位置平均内移2.3±1.6mm（0.6~4.4mm）。术后1周时胫后神经SEP P40波幅与潜伏期为2.10±0.35μV和35.54±2.12ms，与术前比较明显改善（P<0.05）。神经功能均有明显改善。结论：脊髓内移后路矫形内固定治疗伴神经损害的脊柱侧后凸畸形术后患者神经电生理指标和神经功能均明显改善。

英文摘要:

  【Abstract】 Objectives: To assess the neurological outcomes of transvertebral transposition of the spinal cord and posterior correction in patients suffering from neurologic deficit secondary to kyphoscoliosis. Methods: From January 2005 to January 2014, fourteen patients with at least 1-year follow-up, including 6 females and 8 males, suffering from neurologic deficit secondary to angular kyphoscoliosis and undergoing transvertebral transposition of the spinal cord and posterior correction in our spinal center were reviewed retrospectively. The initial age averaged 22.0±14.5 years(range, 6-53 years). The etiologies of deformity were congenital kyphoscoliosis in 10 patients and idiopathic kyphoscoliosis in 4 patients. Preoperative spinal cord function graded by Frankel criteria was grade C in 5 cases and grade D in 9 cases. The initial major curve was 76.9°±33.2°(range, 65°-100°) with a global kyphosis of 71.5°±31.8°(range, 41°-125°). Neurological examinations were performed before surgery and 1 week after discharge. The change of distance between spinal cord and canal on the convex side at the apex was measured on MR images to evaluate the efficacy of transposition. Results: There were no significant changes in terms of the latency and amplitude of posterior tibial nerve P40 intraoperatively (amplitude: 1.67±0.38μV vs. 1.69±0.36μV, P>0.05; latency: 38.96±2.51ms vs. 38.15±2.14ms, P>0.05), while significant improvements were observed postoperatively(amplitude: 1.67±0.38μV vs. 2.10±0.35μV, P<0.05; latency: 38.96±2.51ms vs. 35.54±2.12ms, P<0.05). The distance between spinal cord and canal on the convex side at the apex changed from 11.9mm(range, 3-21.8mm) to 9.8mm(range, 1.8-17.1mm) (t=4.170，P=0.004), decreased by 2.3±1.6mm on average(range, 0.6-4.4mm). After surgery, the major curve improved to 39.3°±19.0°(range, 15°-55°) with a (50.3±20.6)%(range, 14.5%-85%) correction rate, and the mean loss of correction was 6.2%(range, 1.8%-20%). The mean kyphosis was 41.3°±15.4°(range, 22°-69°), demonstrating a (39.0±17.7)%(range, 20.8%-57.9%) correction rate immediately after operation, and showing a 3.2%(range, 5.2%-10%) correction loss at the final follow-up. Conclusions: Transvertebral transposition of the spinal cord is a useful procedure for the treatment of neurologic deficit secondary to angular kyphoscoliosis, with good neurological recovery.