PDF(Pubmed)
Abstract：
OBJECTIVE: H-reflex is a well known neurophysiological test used to evaluate sensory afferent and motor efferent impulses of S1 root. Despite its simplicity and feasibility, it is not used very often in the operating room.
METHODS: We report the case of a 16-year-old male patient who undergoes a surgical correction for a severe paralytic scoliosis (160°). On account of previous deficits, intraoperative neurophysiological monitoring was achieved through TcMEP and H-reflex.
RESULTS: Intraoperative neurophysiological monitoring (IONM) showed a transient and simultaneous loss of bilateral TcMEP and H-reflex, coinciding with an abrupt hypotension during pedicle screw placement. After having dismissed mechanical injury and after increasing blood pressure, TcMEP and H-reflex were equivalent to those at baseline.
CONCLUSIONS: The H-reflex is a classic neurophysiological test not used very frequently in the operating room. It is a feasible and reliable technique that can be helpful during spine surgery IONM, especially in patients with preexisting neurological deficits. Although simultaneous TcMEP and H-reflex monitoring has been previously described, to our knowledge, this is the first recorded case of a decline in both associated with abrupt hypotension.
METHODS: We report the case of a 16-year-old male patient who undergoes a surgical correction for a severe paralytic scoliosis (160°). On account of previous deficits, intraoperative neurophysiological monitoring was achieved through TcMEP and H-reflex.
RESULTS: Intraoperative neurophysiological monitoring (IONM) showed a transient and simultaneous loss of bilateral TcMEP and H-reflex, coinciding with an abrupt hypotension during pedicle screw placement. After having dismissed mechanical injury and after increasing blood pressure, TcMEP and H-reflex were equivalent to those at baseline.
CONCLUSIONS: The H-reflex is a classic neurophysiological test not used very frequently in the operating room. It is a feasible and reliable technique that can be helpful during spine surgery IONM, especially in patients with preexisting neurological deficits. Although simultaneous TcMEP and H-reflex monitoring has been previously described, to our knowledge, this is the first recorded case of a decline in both associated with abrupt hypotension.
摘要：
目的：H反射是一种众所周知的神经生理学测试，用于评估S1根的感觉传入和运动传出冲动。尽管它简单可行,它在手术室中并不经常使用。
方法：我们报告一例16岁男性患者因严重麻痹性脊柱侧凸（160°）接受手术矫正。由于以前的赤字，通过TcMEP和H反射实现术中神经生理监测。
结果：术中神经生理监测（IONM）显示双侧TcMEP和H反射的短暂且同时丧失，与椎弓根螺钉置入期间的突然低血压相吻合。在解除机械性损伤和血压升高后，TcMEP和H反射与基线时相当。
结论：H反射是一种在手术室中不经常使用的经典神经生理学测试。这是一种可行和可靠的技术，可以在脊柱手术IONM中有所帮助，尤其是先前存在神经功能缺损的患者。尽管先前已经描述了同时进行TcMEP和H反射监测，根据我们的知识，这是有记录的首例与突发性低血压相关的两者均下降。
方法：我们报告一例16岁男性患者因严重麻痹性脊柱侧凸（160°）接受手术矫正。由于以前的赤字，通过TcMEP和H反射实现术中神经生理监测。
结果：术中神经生理监测（IONM）显示双侧TcMEP和H反射的短暂且同时丧失，与椎弓根螺钉置入期间的突然低血压相吻合。在解除机械性损伤和血压升高后，TcMEP和H反射与基线时相当。
结论：H反射是一种在手术室中不经常使用的经典神经生理学测试。这是一种可行和可靠的技术，可以在脊柱手术IONM中有所帮助，尤其是先前存在神经功能缺损的患者。尽管先前已经描述了同时进行TcMEP和H反射监测，根据我们的知识，这是有记录的首例与突发性低血压相关的两者均下降。
