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

English Keywords:Cervical spine surgery  Neurophysiologic monitoring  Operation  Spinal cord function

English Abstract:

  【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．