多模态神经电生理监测技术在胸椎管狭窄症手术中的应用价值及硬膜骨化的影响

Value of multimodal neuroelectrophysiological monitoring during thoracic spinal stenosis surgery and impact of dural ossification

中文关键词:  胸椎管狭窄症  体感诱发电位  运动诱发电位  椎管扩大减压植骨融合内固定术  术中监测

英文关键词:Thoracic spinal stenosis  Somatosensory evoked potentials  Motor evoked potentials  Thoracic spinal canal decompression,bone graft fusion, andinternal fixation  Intraoperative monitoring

中文摘要:

  【摘要】 目的：评估体感觉诱发电位（somatosensory evoked potentials，SEPs）联合运动诱发电位（motor evoked potentials，MEPs）在胸椎管狭窄症手术中的应用价值，并评估合并硬膜骨化（dura ossification，DO）对减压术中神经电生理监测（intraoperative neurophysiological monitoring，IONM）异常的影响。方法：选取2024年5月~2025年5月在我院进行胸椎管扩大减压植骨融合内固定术的79例胸椎管狭窄症患者，术中均行SEPs和MEPs监测，回顾性分析患者术中SEPs和MEPs的监测资料。对单模式SEPs、单模式MEPs和SEPs与MEPs联合模式监测的出波率、报警率、真假阳性率、真假阴性率进行统计；采用受试者工作特征（receiver operating characteristic，ROC）曲线分析SEPs和MEPs联合监测的监测效能。比较合并DO患者（DO组）和不伴DO患者（不伴DO组）患者患侧与健侧SEPs和MEPs的潜伏期及波幅差异。结果：单模式SEPs监测的出波率为82.3%（65/79），报警率为6.2%（4/65）；单模式MEPs监测的出波率为72.2%（57/79），报警率为8.8%（5/57）；联合监测的出波率为86.1%（68/79），报警率为4.4%（3/68）。三种模式的出波率、报警率、真假阳性率、真假阴性率均无统计学差异（P＞0.05）。ROC曲线显示，联合监测的ROC曲线下面积（area under curve，AUC）为0.76，高于单模式SEPs监测（0.66）和单模式MEPs监测（0.74）；联合监测的灵敏度、特异度分别为83.3%、75.3%。与不伴DO组患者比较，伴DO组患者双侧MEPs、SEPs的波幅均无统计学差异（P＞0.05），双侧MEPs、SEPs的潜伏期均显著性延长（P＜0.05）。结论：联合应用SEPs和MEPs监测有助于发现胸椎狭窄症患者手术中早期神经损伤，降低术中不可逆的神经损害。在合并DO患者的监测中，IONM表现为SEPs、MEPs的潜伏期明显延长。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical values of somatosensory evoked potentials(SEPs) combined with motor evoked potentials(MEPs) during surgery for thoracic spinal stenosis(TSS), and to evaluate the effect ofdura ossification(DO) on the abnormalities of intraoperative neurophysiological monitoring(IONM). Methods: A retrospective analysis was conducted on 79 TSS patients who underwent thoracic spinal canal decompression, bone graft fusion, and internal fixation at our hospital from May 2024 to May 2025. SEPs and MEPs were monitored intraoperatively for all patients. The monitoring data of SEPs and MEPs during surgery were analyzed. Statistical analysis was performed on the occurrence rate, alarm rate, true and false positive rates, and true and false negative rates for single-mode SEPs, single-mode MEPs, and combined mode of SEPs-MEPs monitoring. Receiver operating characteristic(ROC) curves were used to evaluate the effectiveness of different monitoring modes. Additionally, the latency and amplitude differences between the affected and healthy sides in the DO group and the non-DO group were compared. Results: The occurrence rate for single-mode SEP monitoring was 82.3%(65/79) with an alarm rate of 6.2%(4/65); For single-mode MEPs monitoring, it was 72.2%(57/79) with an alarm rate of 8.8%(5/57); For combined mode, it was 86.1%(68/79) with an alarm rate of 4.4%(3/68). There were no statistically significant differences in occurrence rate, alarm rate, true and false positive rates, and true and false negative rates betweenthe three monitoring methods(P>0.05). The ROC curve showed that the area under the curve(AUC) for combined monitoring was 0.76, which was higher than that for single-mode SEPs(0.66) and single-mode MEPs(0.74). The sensitivity and specificity of combined monitoring were 83.3% and 75.3%, respectively. Compared with the non-DO group, there were no statistically significant differences in the amplitude of bilateral MEPs and SEPs in the DO group(P>0.05). However, the latency of bilateral MEPs and SEPs was significantly prolonged(P<0.05). Conclusions: The combined application of SEPs and MEPs monitoring can help to detect early nerve injury in TSS patients and reduce irreversible nerve damage during surgery. In TSS patients with DO, IONM shows a significantly prolonged latency of SEPs and MEPs.