Application of multi-modality intraoperative neurophysiological monitoring in posterior lumbar open surgery and percutaneous endoscopic lumbar discectomy

English Keywords:Neurophysiological monitoring  Somatosensory evoked potential  Transcranial electrical stimulation motor evoked potential  Free-electromyography  Percutaneous endoscopic lumbar discectomy  Posterior lumbar open surgery

English Abstract:

  【Abstract】 Objectives: To explore the necessity and clinical value of multi-modality intraoperative neurophysiological monitoring(IONM) in posterior lumbar open surgery and percutaneous endoscopic lumbar discectomy(PELD). Methods: Multi-modality IONM was applied in patients undergoing posterior lumbar open surgery and PELD surgery from April 2021 to May 2024 in our hospital. 70 patients undergoing posterior lumbar open surgery and were monitored with cortical somatosensory evoked potential(SEP) and transcranial electrical stimulation motor evoked potential(TES-MEP) were included in the open group, including 29 males and 41 females, aged 8-85 years(33.3±22.4 years); 70 patients undergoing PELD surgery and were monitored with SEP, TES-MEP and free-electromyography(Free-EMG) were included in PELD group, including 36 males and 34 females, aged 13-83 years(50.9±15.2 years). The effectiveness of different monitoring modes in predicting nerve injury in the two types of operation was analyzed. Results: Intraoperative neurophysiological monitoring was effectively implemented in the two groups with no complications related to neurophysiological monitoring. There were two patients showed decreased amplitude of intraoperative neurophysiological signals in the open group, while there were 6 intraoperative neurophysiological abnormalities in PELD group. After early warning and reasonable counter measures, no serious and irreversible nerve function injury occurred in the patients after surgery. Abnormal neuroelectrophysiological signals caused by PELD surgery were manifested as abnormal changes in Free-EMG or TES-MEP, and the changes of TES-MEP signal were not directly related to Free-EMG, indicating that TES-MEP and Free-EMG had independent nerve monitoring functions. Conclusions: Multi-modality IONM has its effectiveness and clinical value in posterior lumbar open surgery and PELD; There is a high risk of warning during PELD surgery, so multi-modality IONM has important clinical value for PELD surgery.