What Is the Best Multimodality Combination for Intraoperative Spinal Cord Monitoring of Motor Function? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.
What Is the Best Multimodality Combination for Intraoperative Spinal Cord Monitoring of Motor Function? A Multicenter Study by the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research.
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DOI：
10.1055/s-0035-1559582
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发表时间：
2016-05
影响因子：
2.4
通讯作者：
Tani T
中科院分区：
文献类型：
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作者：
Ito Z;Matsuyama Y;Ando M;Kawabata S;Kanchiku T;Kida K;Fujiwara Y;Yamada K;Yamamoto N;Kobayashi S;Saito T;Wada K;Satomi K;Shinomiya K;Tani T
研究设计外科医生调查。目的根据收集到的数据，分析多模式术中监测（MIOM）不同方法组合的效果，确定最佳组合。方法对72家培训机构进行问卷调查，对近5年的监测数据进行分析整理，得出以下数据：(1)监测类型；（二）疾病名称和病种；(3)麻醉条件；(4)刺激条件、被监测肌肉及其数量；(5)并发症;(6)术前和术后手工肌肉检查，有无感觉障碍，术后运动障碍持续时间。检查各监测类型的敏感性、特异性、假阳性率、假阴性率，以及各监测类型与术后运动障碍时间的关系。结果经颅电刺激运动诱发电位(TcMEP) +脑电刺激后脊髓诱发电位（Br-SCEP）组合灵敏度最高（90%）。TcMEP +体感诱发电位（SSEP）和TcMEP +脊髓刺激后诱发电位（Sp-SCEP）组合的敏感性均为80%，与单独使用TcMEP时的敏感性差异不大。Br-SCEP + Sp-SCEP（即不包括TcMEP的情况）的灵敏度低至50%。结论术中脊髓监测的最佳多模态组合为TcMEP + Br-SCEP，其灵敏度最高（90%），假阳性率最低（6.1%），假阴性率最低（0.2%）。
Study Design Surgeon survey. Objective To analyze multimodal intraoperative monitoring (MIOM) for different combinations of methods based on the collected data and determine the best combination. Methods A questionnaire was sent to 72 training institutions to analyze and compile data about monitoring that had been conducted during the preceding 5 years to obtain data on the following: (1) types of monitoring; (2) names and number of diseases; (3) conditions of anesthesia; (4) condition of stimulation, the monitored muscle and its number; (5) complications; and (6) preoperative and postoperative manual muscle testing, presence of dysesthesia, and the duration of postoperative motor deficit. Sensitivity and specificity, false-positive rates, and false-negative rates were examined for each type of monitoring, along with the relationship between each type of monitoring and the period of postoperative motor deficit. Results Comparison of the various combinations showed transcranial electrical stimulation motor evoked potential (TcMEP) + cord evoked potential after stimulation to the brain (Br-SCEP) combination had the highest sensitivity (90%). The TcMEP + somatosensory evoked potential (SSEP) and TcMEP + spinal cord evoked potential after stimulation to the spinal cord (Sp-SCEP) combinations each had a sensitivity of 80%, exhibiting little difference between their sensitivity and that obtained when TcMEP alone was used. Meanwhile, the sensitivity was as low as 50% with Br-SCEP + Sp-SCEP (i.e., the cases where TcMEP was not included). Conclusions The best multimodality combination for intraoperative spinal cord monitoring is TcMEP + Br-SCEP, which had the highest sensitivity (90%), the lowest false-positive rate (6.1%), and the lowest false-negative rate (0.2%).