Clinical Outcomes of Intraoperative Contrast-Enhanced Ultrasound Compared with Intraoperative Neurophysiological Monitoring During Circumferential Decompression for Myelopathy Associated with Thoracic-Ossification of the Posterior Longitudinal Ligament
Clinical Outcomes of Intraoperative Contrast-Enhanced Ultrasound Compared with Intraoperative Neurophysiological Monitoring During Circumferential Decompression for Myelopathy Associated with Thoracic-Ossification of the Posterior Longitudinal Ligament
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与后纵韧带胸椎骨化相关的脊髓病环周减压时术中超声造影与术中神经生理学监测的临床结果比较
DOI：
10.12659/msm.921129
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Zhongjun Liu
中科院分区：
文献类型：
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作者：
Xiaosong Yang;Xiao Liu;X. Liu;Miao Yu;Ling Jiang;Yue Ma;L. Tao;Zhongjun Liu
背景椎板切除不能达到足够的腹侧减压时，环状减压(CD)是脊髓病合并胸椎后纵韧带骨化(T-OPLL)的基本治疗选择。虽然术中神经生理监测(IONM)应用广泛，但手术风险相对较高。这项研究首次描述了在人类胸椎手术中使用对比增强超声(CEUS)评估脊髓血流量(SCBF)。本研究的目的是比较术中CEUS和IONM在CD术中的临床结果。材料/方法回顾分析2007-2014年间68例接受CD的T-OPLL患者的临床资料。所有患者均行IONM术。对18例患者进行以下两次超声心动图检查：第一次测量是在椎板切除后，第二次测量是在腹侧减压后。用Hirabayashi恢复率(HRR)评价疗效。结果所有患者的总HRR为56.7%。在CEUS方面，A组的HRR为20.0%(SCBF降低)，B组为63.6%(SCBF增加)，表明A组的神经预后明显较差(P<；0.01)。关于IONM，C组(电势没有显著变化)、D组(电势变化达到警示标准)和E组(电势改善)之间的HRR没有显著差异。结论IONM对诊断即将发生的脊髓功能障碍较为有效。术中超声是评估SCBF变化的一种安全可靠的方法，可作为IONM的补充，从而减少假阴性结果的发生。
Background Circumferential decompression (CD) is an essential treatment option for myelopathy associated with thoracic-ossification of the posterior longitudinal ligament (T-OPLL) when laminectomy cannot achieve sufficient ventral decompression. Although intraoperative neurophysiological monitoring (IONM) is widely used, the operation has a relatively high risk. This study is the first to describe the use of contrast-enhanced ultrasound (CEUS) to evaluate the spinal cord blood flow (SCBF) during thoracic spine surgery in humans. The objective of this study was to compare clinical outcomes between intraoperative CEUS and IONM during CD. Material/Methods Sixty-eight T-OPLL patients who received CD from 2007 to 2014 were reviewed. All patients underwent IONM. CEUS was used on the following 2 occasions on 18 patients to evaluate SCBF: the first measurement was performed after laminectomy and the second after ventral decompression. Outcomes were evaluated by the Hirabayashi recovery rate (HRR). Results The overall HRR of all patients was 56.7%. Regarding CEUS, the HRR was 20.0% in Group A (SCBF decreased) and 63.6% in Group B (SCBF increased), indicating a significantly poorer neurological outcome in Group A (P<0.01). Regarding IONM, the HRR did not significantly differ between Groups C (no meaningful change in potential), D (potential changed up to alert criteria), and E (potential improved). Conclusions IONM is relatively effective in detecting impending spinal cord dysfunction. Intraoperative CEUS is a safe and reliable method for assessing SCBF changes, which may be used as a supplement to IONM, thus reducing the incidence of false-negative results.