The application of neurophysiological monitoring in percutaneous endoscope lumbar discectomy

English Keywords:Spontaneous electromyography  PELD  Neurophysiological monitoring

English Abstract:

  【Abstract】 Objectives: To investigate the application of neurophysiological monitoring in percutaneous endoscope lumbar discectomy(PELD). Methods: A retrospective review was performed on 37 patients(16 males and 21 females) with lumbar disc herniation between April 2014 and July 2014. The mean age was 44.8±17.5 years old. Among these, there were 35 patients with simple lumbar disc herniation and 2 patients combined with spinal stenosis. After local anesthesia, all patients underwent PELD. Spontaneous electromyography(SEMG) was used to monitor nerve root function, and the patient′s subjective feeling(pain) was recorded. The correlation between the SEMG and the patient′s subjective feeling was analyzed. Results: In the process of operation channel placed, all patients showed the low back pain, but SEMG had no obvious change. 2 cases showed no significant leg pain but significantly electrophysiological changes, the electrophysiological changes tended to be normal after adjusting the channel. Leg pain and electrophysiological changes were very obvious in 35 cases. By reminding operator, finding out the reasons and adjusting channel, the leg pain and the changes of neurophysiological monitoring disappeared. In the process of discectomy, all patients had no obvious pain or changes in the electrophysiological monitoring. When decompressing the nerve root, there were a series of significantly potential wave amplitude changes and obvious leg pain. Leg pain disappeared and neurophysiological monitoring returned normal when stopping surgery. When stimulating the nerve root, the patients showed significant EMG response and leg pain. The monitoring results of contralateral body had no significant electrophysiological changes. All patients had no postoperative neurological complications. The true-positive rate of SEMG was 100%, while the true-positive rate of pain was 94.6%, the false-negative rate of pain was 5.4%. Conclusions: Intraoperative SEMG monitoring provides a more objective safety indicator and further improves surgical safety.