Characteristics of Tc-MEP Waveforms in Spine Surgery for Patients with Severe Obesity
Characteristics of Tc-MEP Waveforms in Spine Surgery for Patients with Severe Obesity
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DOI：
10.1097/brs.0000000000004096
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发表时间：
2021-12-15
期刊：
影响因子：
3
通讯作者：
Imagama，Shiro
中科院分区：
文献类型：
--
作者：
Kobayashi，Kazuyoshi;Ando，Kei;Imagama，Shiro
研究设计：前瞻性多中心研究。目的：本研究的目的是评价经颅运动诱发电位(TC-MEP)波形监测在重度肥胖患者脊柱手术中的应用。背景资料摘要：肥胖患者脊柱手术与发病率和死亡率的增加有关。术中TC-MEP监测可以确定手术中神经功能的恶化，但尚未对肥胖患者进行检查。方法：在16个脊柱手术中心，3560例患者在手术中接受了TC-MEP监测。通过针电极或圆盘电极从多条肌肉记录TC-MEP。术中以≥波幅较术前下降70%为警示。结果3560例患者(男性1698例，占47.7%)平均年龄60.0±20.3岁，平均年龄60.0±20.3岁。体重指数<35 kg/m2(n=60，1.7%)为重度肥胖。与所有其他患者(对照组)相比，重度肥胖组的术前运动缺陷发生率(41.0%vs.29.6%，P<；0.05)和所有肌肉中未检测到的基线波形的发生率(20.0%vs.1.7%，P<；0.01)显著增加。术后运动功能恶化在两组之间没有显著差异。预警标准预测术后神经并发症的敏感度和特异度在重度肥胖组分别为75.0%和83.9%，对照组分别为76.4%和89.6%，两组间差异无统计学意义(P>0.05)。结论在脊柱外科重度肥胖组中，TC-MEPS可用于预测术后运动功能障碍，但其波形漏检率明显高于对照组。使用多通道波形方法或多种方式可以促进手术的安全完成。如果出现报警标准，应仔细评估波形并采取适当的抢救措施。证据水平：3在脊柱手术的经颅运动诱发电位监测中，严重肥胖患者(体重指数35 kg/m2)和其他所有患者预测神经系统并发症的敏感性和特异性与≥下降70%的敏感性和特异性相似。然而，波形无法检测的病例在严重肥胖患者中更为常见。
Study Design.Prospective multicenter study.Objective.The aim of this study was to evaluate transcranial motor evoked potential (Tc-MEP) waveform monitoring in spinal surgery for patients with severe obesity.Summary of Background Data.Spine surgeries in obese patients are associated with increased morbidity and mortality. Intraoperative Tc-MEP monitoring can identify neurologic deterioration during surgery, but has not been examined for obese patients.Methods.The subjects were 3560 patients who underwent Tc-MEP monitoring during spine surgery at 16 centers. Tc-MEPs were recorded from multiple muscles via needle or disc electrodes. A decrease in Tc-MEP amplitude of≥ 70% from baseline was used as an alarm during surgery. Preoperative muscle weakness with manual muscle test (MMT) grade≤ 4 was defined as a motor deficit, and a reduction of one or more MMT grade postoperatively was defined as deterioration.Results.The 3560 patients (1698 males, 47.7%) had a mean age of 60.0±20.3 years. Patients with body mass index> 35 kg/m 2 (n= 60, 1.7%) were defined as severely obese. Compared with all other patients (controls), the rates of preoperative motor deficit (41.0% vs. 29.6%, P< 0.05) and undetectable baseline waveforms in all muscles were significantly higher in the severely obese group (20.0% vs. 1.7%, P< 0.01). Postoperative motor deterioration did not differ significantly between the groups. The sensitivity and specificity of the alarm criterion for prediction of postoperative neurologic complications were 75.0% and 83.9% in severely obese patients and 76.4% and 89.6% in controls, with no significant difference between the groups.Conclusion.Tc-MEPs can be used in spine surgery for severely obese cases to predict postoperative motor deficits, but the rate of undetectable waveforms is significantly higher in such cases. Use of a multichannel waveform approach or multiple modalities may facilitate safe completion of surgery. Waveforms should be carefully evaluated and an appropriate rescue procedure is required if the alarm criterion occurs.Level of Evidence: 3In transcranial motor evoked potential monitoring in spine surgery, the sensitivity and specificity of an amplitude decrease of≥ 70% for prediction of neurologic complications were similar in severely obese patients (body mass index> 35 kg/m 2) and all other patients. However, cases with undetectable waveforms were more common among severely obese patients.