Evaluation of a Combination of Waveform Amplitude and Peak Latency in Intraoperative Spinal Cord Monitoring
Evaluation of a Combination of Waveform Amplitude and Peak Latency in Intraoperative Spinal Cord Monitoring
复制标题
术中脊髓监测中波形幅度和峰值潜伏期组合的评估
DOI：
10.1097/brs.0000000000002579
复制
发表时间：
2018
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;Shinjo Ryuichi;Ito Kenyu;Tsushima Mikito;Morozumi Masayoshi;Tanaka Satoshi;Machino Masaaki;Ota Kyotaro;Ishiguro Naoki;Imagama Shiro
研究设计：回顾性研究：目的：本研究的目的是调查经颅肌肉动作电位（Tc-MsEP）波形监测中潜伏期变化的意义。背景资料概要：Tc-MsEP由于其对运动功能的敏感性和重要性，已成为脊柱手术中的常用方法。许多报告已定义的报警点的Tc-MsEP波形作为一个特定的幅度下降，但评价的波形潜伏期并没有引起太多的attention.Methods.The subjects是70例接受脊柱手术使用术中Tc-MsEP监测。峰值潜伏期定义为从刺激到波形幅度达到其峰值的时间段。与术后瘫痪的关系分别检查潜伏期延迟5%或以上和10%或以上，并结合从baseline.Results.Acceptable基线Tc-MsEP反应的幅度减少70%或以上，从1225 1372肌肉四肢（89.3%）。70例患者中有7例（10%）术后瘫痪。25例患者术中振幅较基线降低70%或以上，预测术后瘫痪的敏感性为100%，特异性为71%，假阳性率为29%，阳性预测值（PPV）为28%。与基线相比，15例患者的潜伏期延迟5%或以上，敏感性为100%，特异性为87%，假阳性率为0%，PPV为47%; 8例患者的潜伏期延迟10%或以上，敏感性为86%，特异性为97%，假阳性率为3%，PPV为75%。振幅较基线降低70%或以上和潜伏期较基线延迟10%或以上的组合的敏感性为86%，特异性为98%，假阳性率为2%，PPV为86%.Conclusion.潜伏期和振幅的联合使用可导致Br（E）-MsEP监测中假阳性率降低和PPV增加。证据等级：3术中脊髓监测对预防术后瘫痪的重要性已被广泛认识。1-8经颅肌肉动作电位（Tc-MsEP）波形、脑刺激脊髓诱发电位（D波）和体感诱发电位（SSEP）已用于此目的。特别是，Tc-MsEP广泛用于术中脊髓监测，由于其对运动功能的敏感性和重要性增加，这已成为一种常用方法。2，5，6以前有关于Tc-MsEP的报警点的报告，基于波形振幅的降低，但波形潜伏期的评估很少受到关注。在这项研究中，我们研究了Tc-MsEP monitoring.MATERIALS和METHODSSubjectsThe主体的潜伏期的特点进行了脊柱手术，使用术中Tc-MsEP监测在我们的机构，与1372肌肉在四肢选择监测。患者的平均年龄为43岁（范围，10-72岁），41名女性和29名男性。疾病包括髓外硬膜内肿瘤（n= 26）、青少年特发性脊柱侧凸（n= 16）、后纵韧带骨化/黄韧带骨化（n= 9）、脊髓髓内肿瘤（n= 11）、先天性脊柱侧凸（n= 3）和其他（n= 5）。峰值潜伏期定义为从刺激到波形振幅达到峰值的时间（图1）。根据与基线时峰值潜伏期的比较定义潜伏期延迟百分比：[（潜伏期-基线时潜伏期）/基线时潜伏期]× 100。减少术后…
Study Design.Retrospective study.Objective.The goal of the study was to investigate the significance of a change in latency in monitoring of transcranial muscle-action potential (Tc-MsEP) waveforms.Summary of Background Data.Tc-MsEP has become a common approach in spine surgery due to its sensitivity and importance in motor function. Many reports have defined the alarm point of Tc-MsEP waveform as a particular decrease in amplitude, but evaluation of the waveform latency has not attracted as much attention.Methods.The subjects were 70 patients who underwent spine surgery using intraoperative Tc-MsEP monitoring. The peak latency was defined as the period from stimulation until the waveform amplitude reached its peak. Relationships with postoperative paralysis were examined separately for latency delays of 5% or more and 10% or more, and in combination with a decrease in amplitude of 70% or more from baseline.Results.Acceptable baseline Tc-MsEP responses were obtained from 1225 of 1372 muscles in the extremities (89.3%). Seven of the 70 patients (10%) had postoperative paralysis. A decrease in intraoperative amplitude of 70% or more from baseline occurred in 25 cases, with sensitivity 100%, specificity 71%, false positive rate 29%, and positive predictive value (PPV) 28% for prediction of postoperative paralysis. Compared to baseline, 15 cases had a latency delay of 5% or more, which gave a sensitivity of 100%, specificity of 87%, false positive rate of 0%, and PPV 47%, and 8 cases had a delay of 10% or more, which gave a sensitivity of 86%, specificity of 97%, false positive rate of 3%, and PPV 75%. A combination of a decrease in amplitude of 70% or more from baseline and a delay in latency of 10% or more from baseline had a sensitivity of 86%, specificity of 98%, and a false positive rate of 2%, and PPV 86%.Conclusion.Combined use of latency and amplitude could lead to reduction of false positives and increase of PPV in Br (E)-MsEP monitoring.Level of Evidence: 3The importance of intraoperative spinal cord monitoring for prevention of postoperative paralysis is widely understood. 1–8 Transcranial muscle-action potential (Tc-MsEP) waveforms, brain-stimulated spinal cord–evoked potentials (D-waves), and somatosensory-evoked potentials (SSEPs) have been used for this purpose. 4, 7, 8 In particular, Tc-MsEPs are widely used for intraoperative spinal cord monitoring, and this has become a common approach due to its increased sensitivity and importance for motor function. 2, 5, 6 There are previous reports on alarm points for Tc-MsEP based on a decrease in waveform amplitude, but evaluation of the waveform latency has attracted less attention. In this study, we examined the characteristics of latency in Tc-MsEP monitoring.MATERIALS AND METHODSSubjectsThe subjects were 70 patients who underwent spine surgery using intraoperative Tc-MsEP monitoring at our institution, with 1372 muscles in the extremities chosen for monitoring. The patients had a mean age of 43 years (range, 10–72), and 41 were women and 29 were men. Diseases included intradural extramedullary tumor (n= 26), adolescent idiopathic scoliosis (n= 16), ossification of posterior longitudinal ligament/ossification of the ligamentum flavum (n= 9), spinal intramedullary tumor (n= 11), congenital scoliosis (n= 3), and others (n= 5). The peak latency was defined as the period from stimulation until the waveform amplitude reached its peak (Figure 1). The percentage latency delay was defined based on comparison with the peak latency at baseline:[(latency-latency at baseline)/latency at baseline]× 100. A decrease in the postoperative …
登录
查看更多内容
影响因子：
3
作者：
Muramoto, Akio;Imagama, Shiro;Ishigro, Naoki
通讯作者：
Ishigro, Naoki
影响因子：
2.4
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
通讯作者：
Tani T
影响因子：
2.8
作者：
Ito, Zenya;Matsuyama, Yukihiro;Tani, Toshikazu
通讯作者：
Tani, Toshikazu
髓内脊髓肿瘤切除过程中经颅运动诱发电位的变化与术后运动功能相关
影响因子：
4.8
作者：
A. Quiñones‐Hinojosa;Russ Lyon;G. Zada;K. Lamborn;N. Gupta;A. Parsa;M. McDermott;P. Weinstein
通讯作者：
P. Weinstein
DOI：
10.1016/j.neucli.2007.07.007
发表时间：
2007-12-01
影响因子：
3
作者：
Langeloo, D. -D.;Journee, H. -L.;Grotenhuis, J. A.
通讯作者：
Grotenhuis, J. A.