脊髓型颈椎病前路手术中神经电生理监测的应用

摘要

Objective To summarize the experiences of intraoperative neurophysiological monitoring in anterior surgery for cervical spondylotic myelopathy.Methods A retrospective review was performed on 35 patients with spondylotic myelopathy who received intraoperative neurophysiological monitoring.Results The waveforms of somatosensory evoked potential(SEP) and motor evoked potential (MEP) were monitored in all 35 cases.The SEP and MEP alert occurred in 4 cases and 7 cases respectively.The amplitude of SEP increased in 29 cases, unchanged in 5 cases, and decreased in 1 case after decompression.The amplitude of MEP increased in 31 cases, unchanged in 2 cases, and decreased in 2 cases after decompression.The score of JOA was 7.94±1.54 and 12.23±1.51 before and 1 month after operation respectively, which was significant difference(P<0.01).Conclusions The combined application of SEP and MEP intraoperative monitoring can timely monitor the functional integrity of cervical spinal cord,and improve the safety of anterior cervical surgery.%目的 总结脊髓型颈椎病前路手术中应用神经电生理监测技术的经验.方法 回顾性分析35例脊髓型颈椎病患者前路手术中应用神经电生理监测的临床资料.结果 35例术中均能监测到体感诱发电位(SEP)及运动诱发电位(MEP)的波形,术中出现SEP和MEP预警者分别为4例和7例.椎管减压后SEP波幅升高29例,无明显变化5例,轻度下降1例.椎管减压后MEP波幅升高31例,无明显变化2例,轻度下降2例.JOA评分术前为7.94分±1.54分,术后1个月为12.23分±1.51分,差异有统计学意义(P<0.01).结论 联合应用SEP和MEP可以实时监测术中脊髓的功能状态,提高手术安全性.