术中经颅电刺激运动诱发电位和皮层体感诱发电位联合监护与唤醒试验判断脊髓功能

目的 探讨术中经颅电刺激运动诱发电位(TES-MEP)和皮层体感诱发电位(CSEP)联合监护与唤醒试验判断脊髓功能的作用.方法 2006年7月至2010年3月中山大学附属第一医院脊柱外科脊柱手术中同时实施TES-MEP和CSEP联合监护426例,并对术中出现阳性和仔细检查后原因不明或纠正手术操作后仍没有恢复的23例进行唤醒试验.根据术中联合监护和唤醒试验结果,分别与术后脊髓功能进行比较.结果 联合监护阳性64例(15%),其中51例与脊髓功能符合,另13例不符合.假阳性占3.1%(13/426).本组无假阴性.联合监护判断脊髓功能灵敏度为100%(51151),特异度96.5%(362/375),约登指数0.965.23例唤醒试验中,8例阳性均与脊髓功能符合,没有假阳性.而15例阴性中,与脊髓功能符合9例,不符合6例.唤醒试验判断脊髓功能的灵敏度为57.1%(8/14)、特异度100%(9/9)、约登指数0.571.结论 TES.MEP和CSEP联合监护为目前脊柱外科手术监护的理想选择和首选方法,唤醒试验可用于联合监护真假阳性鉴别的检测.

Role of combined monitoring of TES-MEP and CSEP during spinal surgery and wake-up test in evaluating the spinal cord function

Objective To explore the role of combined monitoring of transcranial electrical stimulation motor evoked potential (TES-MEP) and cortical somatosensory evoked potential (CSEP) during spinal surgery and wake-up test in evaluating the spinal cord function.Methods Between July 2006 and March 2010, combined intraoperative monitoring of TES-MEP and CSEP was performed in 426 patients registered to Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University.Moreover,wake-up tests were performed in 23 positive cases with causes unclear after a detailed workup or no recovery after modification of the surgery procedures.The post-operative spinal function was then compared between the combined monitoring and wake-up test, respectively.Results Sixty-four cases were found positive.Notably, fifty-one of them had consistent spinal function, and the remaining 13 cases were found inconsistent and false positive (3.1%, 13/426).No case with false negative results was found.The combined monitoring yielded 100%(51/51) sensitivity, 96.5%(362/375) specificity and a Youden index of 0.965.Of 23 wake-up tested cases, 8 positive cases were found with consistent spinal function, with no false positive cases found.However, of the remaining 15 negative cases, only 9 were found with consistent spinal function.The wake-up test yielded 100% (9/9) sensitivity, 57.1%(8/14) specificity and a Youden index of 0.571.Conclusions The combined monitoring of TES-MEP and CSEP is considered as an ideal alternative and a preferred method in monitoring the spinal function during surgery.Wake - up test can be used in verifying the results of combined monitoring.