The Utility of Transcranial Stimulated Motor-Evoked Potential Alerts in Cervical Spine Surgery Varies Based on Preoperative Motor Status.
The Utility of Transcranial Stimulated Motor-Evoked Potential Alerts in Cervical Spine Surgery Varies Based on Preoperative Motor Status.
复制标题
经颅刺激运动诱发电位警报在颈椎手术中的效用因术前运动状态而异。
DOI：
10.1097/brs.0000000000004448
复制
发表时间：
2022
期刊：
影响因子：
3
通讯作者：
Ando K,
中科院分区：
文献类型：
--
作者：
Funaba Masahiro;Kanchiku T;Kobayashi K;Yoshida G;Machino M;Yamada K;Shigematsu H;Tadokoro N;Ushirozako H;Takahashi M;Yamamoto N;Morito S;Kawabata S;Fujiwara Y;Ando M;Taniguchi S;Iwasaki H;Wada K;Yasuda A;Hashimoto J;Takatani T;Ando K,
研究设计。一项前瞻性多中心观察性研究。目的。目的是调查经颅运动诱发电位（Tc-MEP）在颈椎手术中的有效性，并确定发生 Tc-MEP 警报时与阳性预测值相关的因素。背景数据摘要。Tc-MEP 检测运动麻痹的敏感性和特异性较高；材料和方法。作者检查了 2476 例颈椎手术的 Tc-MEP，并比较了患者背景、脊柱疾病类型、术前运动状态、手术因素和 Tc-MEP 警报类型。 Tc-MEP 警报被定义为与控制波形相比幅度降低超过 70%。 Tc-MEP结果分为假阳性和真阳性两组，通过单因素分析提取有显着差异的项目，通过多因素分析进行检测。结果：总体敏感性为66%（节段性瘫痪：33%，下肢瘫痪：95.8%），特异性为91.5%。 Tc-MEP 结果为 33 例真阳性和 233 例假阳性。严重运动状态病例中普通脊柱手术的阳性预测值显着高于非严重运动状态病例（19.5% vs. 6.7%，P=0.02），但在高风险脊柱手术中没有差异（20.8% vs. 19.4%）。然而，无论运动状态如何，抢救率均无显着差异（48% 与 50%）。在多变量 Logistic 分析中，术前严重运动状态 [P= 0.041，比值比 (OR)：2.46，95% 置信区间 (95% CI)：1.03–5.86] 和硬膜内肿瘤切除期间的 Tc-MEP 警报（P< 0.001，OR：7.44，95% CI：2.64–20.96）与真阳性，而无法通过手术操作识别的 Tc-MEP 警报（P= 0.011，OR：0.23，95% CI：0.073-0.71）与假阳性相关。 结论。 Tc-MEP 在术前严重运动状态的患者中的效用得到增强，即使对于那些没有进行高风险脊柱手术的患者也是如此。无论运动状态如何，Tc-MEP 警报后的适当干预可能会预防术后瘫痪。
Study Design.A prospective multicenter observational study.Objective.The aim was to investigate the validity of transcranial motor-evoked potentials (Tc-MEP) in cervical spine surgery and identify factors associated with positive predictive value when Tc-MEP alerts are occurred.Summary of Background Data.The sensitivity and specificity of Tc-MEP for detecting motor paralysis are high; however, false-positives sometimes occur.Materials and Methods.The authors examined Tc-MEP in 2476 cases of cervical spine surgeries and compared patient backgrounds, type of spinal disorders, preoperative motor status, surgical factors, and the types of Tc-MEP alerts. Tc-MEP alerts were defined as an amplitude reduction of more than 70% from the control waveform. Tc-MEP results were classified into two groups: false-positive and true-positive, and items that showed significant differences were extracted by univariate analysis and detected by multivariate analysis.Results.Overall sensitivity was 66%(segmental paralysis: 33% and lower limb paralysis: 95.8%) and specificity was 91.5%. Tc-MEP outcomes were 33 true-positives and 233 false-positives. Positive predictive value of general spine surgery was significantly higher in cases with a severe motor status than in a nonsevere motor status (19.5% vs. 6.7%, P= 0.02), but not different in high-risk spine surgery (20.8% vs. 19.4%). However, rescue rates did not significantly differ regardless of motor status (48% vs. 50%). In a multivariate logistic analysis, a preoperative severe motor status [P= 0.041, odds ratio (OR): 2.46, 95% confidence interval (95% CI): 1.03–5.86] and Tc-MEP alerts during intradural tumor resection (P< 0.001, OR: 7.44, 95% CI: 2.64–20.96) associated with true-positives, while Tc-MEP alerts that could not be identified with surgical maneuvers (P= 0.011, OR: 0.23, 95% CI: 0.073–0.71) were associated with false-positives.Conclusion.The utility of Tc-MEP in patients with a preoperative severe motor status was enhanced, even in those without high-risk spine surgery. Regardless of the motor status, appropriate interventions following Tc-MEP alerts may prevent postoperative paralysis.