Wave changes in intraoperative transcranial motor-evoked potentials during posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament.
Wave changes in intraoperative transcranial motor-evoked potentials during posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament.
复制标题
后纵韧带胸椎骨化器械后减压和去后凸矫正融合术中术中经颅运动诱发电位的波变化。
DOI：
10.1007/s00590-019-02435-1
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Imagama S
中科院分区：
文献类型：
--
作者：
Ando K;Kobayashi K;Machino M;Ota K;Morozumi M;Tanaka S;Ishiguro N;Imagama S
背景对胸椎后纵韧带 (T-OPLL) 手术患者的术中经颅运动诱发电位 (TcMEP) 振幅进行前瞻性临床研究。目的探讨 T-OPLL 后路减压和去后凸矫正融合术中 T-OPLL 的术中 TcMEP。方法研究对象为 33 例接受后路减压的患者，术中平均年龄 48 岁。并在术中 TcMEP 监测下与仪器融合。记录年龄、性别、BMI、改良麦考密克量表、俯卧位和仰卧位测试（PST）、手术时间、估计失血量和日本骨科协会（JOA）评分。还调查了 TcMEP 的成功出现率、成功出现的相关因素、术中振幅变化、与振幅恶化相关的手术、振幅恢复、与恢复相关的手术以及术后麻痹。结果与其他肌肉相比，外展肌 (AH) 的出现率最高 (83.3%)。振幅恶化的病例有 24 例：暴露期间 6 例，旋入期间 2 例，减压期间 16 例。置棒期间未发生恶化。有 13 名患者（39%）出现术后运动障碍。 BMI、PST 阳性、改良 McCormick 量表 IV 和术前 JOA 评分的病例中，振幅出现率显着较低。结论 AH 肌肉对于皮质脊髓传导的功能评估特别有用。高 BMI、阳性 PST、改良麦考密克量表 IV 和术前低 JOA 评分与低振幅出现率相关。除了在放置杆期间之外，整个手术过程中都会发生幅度恶化，因此快速放置刚性杆很重要。
BackgroundA prospective clinical study of amplitudes of intraoperative transcranial motor-evoked potentials (TcMEPs) was performed in patients undergoing surgery for the posterior longitudinal ligament of thoracic spine (T-OPLL).ObjectiveTo investigate intraoperative TcMEPs during posterior decompression and dekyphotic corrective fusion with instrumentation for T-OPLL.MethodsThe subjects were 33 patients with an average age of 48 years at surgery who underwent posterior decompression and fusion with instrumentation under intraoperative TcMEP monitoring. Age, gender, BMI, modified McCormick scale, prone and supine position test (PST), operative time, estimated blood loss, and Japanese Orthopaedic Association (JOA) score were recorded. Rates of successful appearance of TcMEPs, factors related to successful appearance, intraoperative amplitude changes, procedures related to amplitude deterioration, recovery of amplitude, procedures related to recovery, and postoperative paralysis were also investigated.ResultsThe rate of appearance was highest from the abductor hallucis (AH) (83.3%) compared with other muscles. There were 24 cases with amplitude deterioration: during exposure in 6, screwing in 2, and decompression in 16. No deterioration occurred during rod placement. There were 13 (39%) with postoperative motor deficits. Significantly lower rates of amplitude appearance occurred in cases with BMI, positive PST, modified McCormick scale IV, and preoperative JOA score.ConclusionsAH muscles were particularly useful for functional assessment of corticospinal conduction. High BMI, positive PST, modified McCormick scale IV, and low preoperative JOA score were associated with low rates of amplitude appearance. Amplitude deteriorations occurred throughout surgery, except during rod placement, and speedy rigid rod placement is important.