术中肌电图监测在微创经椎间孔腰椎椎间融合术中的应用

摘要

目的 探讨术中肌电图监测在微创经椎间孔腰椎椎间融合术中应用的可行性和临床疗效.方法 2008年2月～2009年10月对16例行微创经椎间孔腰椎椎间融合治疗的患者进行术中肌电图监测,共18个节段,66枚椎弓根螺钉.椎管减压和椎间植骨融合时应用自发肌电图监测,经皮置入椎弓根螺钉时应用电刺激诱发肌电图监测.患者术后均行CT检查螺钉位置.结果 所有患者在减压过程中无异常肌电反应,2例在置入椎间融合器后出现间断性自发肌电活动.23枚螺钉(34.8%)在置入开路锥的过程中,相应的监测肌肉引出至少1次有意义的肌电活动.3枚攻丝尾部检测<10mA,取出调整后重新置入.术后均无新的神经并发症.术后CT提示上述3个椎弓根皮质骨内侧破裂和1枚穿破外侧皮质骨.结论 术中EMG监测在微创TLIF中是一种监测神经根功能的有效手段.%Objective To determine the effectiveness and clinical result of intraoperative electromyography ( EMG )moni-toring during minimally invasive transforaminal lumbar interbody fusion ( TLIF A Methods Between Feb 2008 and Oct 2009, 16 consecutive patients (18 levels, 66 pedicles )who underwent minimally invasive TLIF received intraoperative EMG monitoring. Spontaneous EMG monitoring was performed during decompression and interbody graft placement. Stimulus-evoked EMG monitoring was performed during the placement of the pedicle access needle, testing of the pedicle tap and screw. All patients underwent postoperative computed tomography ( CT ) scanning. Results In no patient did the authors observe significant EMG activation during decompression. Intermittent nerve root firing was noted after the interbody graft was placed in two cases. Using the active stimulation protocol, 23 ( 34.8% ) of screw placements required one or more changes to the trajectory of the pedicle access needle. 3 ( 4.5% ) pedicle taps induced EMG thresholds<10mA, prompting repositioning. After surgery, no new neurologic deficits were found in all patients. Postoperative computed tomography ( CT ) scanning revealed three cases of pedicle medially breach and one case laterally. Conclusion Intraoperative nerve root monitoring is a useful adjunct to minimally invasive TLIF.