Abstract：
Decompression surgery is a treatment option for patients with degenerative cervical myelopathy (DCM). Surgical decisions primarily depend on clinical symptoms and radiological examinations. The diagnostic and prognostic significance of evoked potential tests for surgical outcomes in patients with DCM has not been thoroughly examined.
To identify the diagnostic and prognostic significance of preoperative evoked potential tests in patients with DCM who underwent decompression surgery.
This was a retrospective observational study.
One hundred two consecutive patients who underwent evoked potential tests and surgical treatment between January 2016 and December 2020 in a single spine center and had a minimum follow-up of 6 months.
Japanese Orthopedic Association (JOA) scores obtained preoperatively and 6 months after surgery.
This study evaluated the preoperative central motor conduction time (CMCT), somatosensory evoked potentials, and Japanese Orthopedic Association (JOA) scores obtained preoperatively and 6 months after surgery.
Abnormal CMCT findings were observed in 94 patients (92.2%). Abnormal somatosensory evoked potentials were observed in 77 patients (75.5%). There was a statistically significant correlation between preoperative JOA score and abductor pollicis brevis (APB)-CMCT (r=-0.546, p=.001), tibialis anterior (TA)-CMCT (r=-0.517, p<.001), median nerve (MN)-SSEP (r=-0.353, p=.001), and tibial nerve (TN)-SSEP (r=-0.349, p=.003). There were significant differences in recovery rates associated with diabetes mellitus (DM), preoperative severity of myelopathy, TA-CMCT, MN-SSEP, and TN-SSEP. Stepwise multiple regression analysis showed that the major factors affecting the clinical outcomes were TN-SSEP (β=0.327, p=.004), preoperative JOA score (β=0.278, p=.012), and DM (β=0.241, p=.025).
Evoked potential testing is a functional diagnostic tool that can indicate the severity of myelopathic symptoms in patients with DCM. Additionally, preoperative TN-SSEP may have significant prognostic value in predicting postoperative clinical outcomes. Thus, preoperative evoked potential tests could be helpful for determining suitable surgical treatment candidates and forecasting postoperative prognosis.
To identify the diagnostic and prognostic significance of preoperative evoked potential tests in patients with DCM who underwent decompression surgery.
This was a retrospective observational study.
One hundred two consecutive patients who underwent evoked potential tests and surgical treatment between January 2016 and December 2020 in a single spine center and had a minimum follow-up of 6 months.
Japanese Orthopedic Association (JOA) scores obtained preoperatively and 6 months after surgery.
This study evaluated the preoperative central motor conduction time (CMCT), somatosensory evoked potentials, and Japanese Orthopedic Association (JOA) scores obtained preoperatively and 6 months after surgery.
Abnormal CMCT findings were observed in 94 patients (92.2%). Abnormal somatosensory evoked potentials were observed in 77 patients (75.5%). There was a statistically significant correlation between preoperative JOA score and abductor pollicis brevis (APB)-CMCT (r=-0.546, p=.001), tibialis anterior (TA)-CMCT (r=-0.517, p<.001), median nerve (MN)-SSEP (r=-0.353, p=.001), and tibial nerve (TN)-SSEP (r=-0.349, p=.003). There were significant differences in recovery rates associated with diabetes mellitus (DM), preoperative severity of myelopathy, TA-CMCT, MN-SSEP, and TN-SSEP. Stepwise multiple regression analysis showed that the major factors affecting the clinical outcomes were TN-SSEP (β=0.327, p=.004), preoperative JOA score (β=0.278, p=.012), and DM (β=0.241, p=.025).
Evoked potential testing is a functional diagnostic tool that can indicate the severity of myelopathic symptoms in patients with DCM. Additionally, preoperative TN-SSEP may have significant prognostic value in predicting postoperative clinical outcomes. Thus, preoperative evoked potential tests could be helpful for determining suitable surgical treatment candidates and forecasting postoperative prognosis.
摘要：
背景：减压手术是退行性颈椎病（DCM）患者的一种治疗选择。手术决定主要取决于临床症状和放射学检查。尚未彻底检查诱发电位测试对DCM患者手术结果的诊断和预后意义。
目的：探讨术前诱发电位试验对DCM患者减压手术的诊断和预后意义。
方法：这是一项回顾性观察性研究。
方法：2016年1月至2020年12月期间，在单个脊柱中心接受诱发电位测试和手术治疗的102名连续患者，至少随访6个月。
方法：日本骨科协会（JOA）在手术前和手术后6个月获得的评分。
方法：本研究评估了术前中央运动传导时间（CMCT），体感诱发电位（SSEP），术前和术后6个月获得日本骨科协会（JOA）评分。
结果：在94例患者中观察到异常的CMCT表现（92.2％）。77例(75.5%)患者出现SSEP异常。术前JOA评分与短腿外展肌(APB)-CMCT之间有统计学意义的相关性(r=-0.546,p=0.000),胫骨前肌（TA）-CMCT（r=-0.517，p<=0.000），正中神经（MN）-SSEP（r=-0.353，p=0.001），和胫神经（TN）-SSEP（r=-0.349，p=0.003）。与糖尿病（DM）相关的康复率存在显着差异，术前脊髓病的严重程度，TA-CMCT,MN-SSEP,和TN-SSEP。逐步回归分析显示,影响临床结局的主要因素为TN-SSEP(β=0.327,p=0.004),术前JOA评分(β=0.278,p=0.012),和DM（β=0.241，p=0.025）。
结论：诱发电位测试是一种功能性诊断工具，可以指示DCM患者的脊髓病变症状的严重程度。此外,术前TN-SSEP在预测术后临床结局方面可能具有重要的预后价值。因此，术前诱发电位测试有助于确定合适的手术治疗方案和预测术后预后.
目的：探讨术前诱发电位试验对DCM患者减压手术的诊断和预后意义。
方法：这是一项回顾性观察性研究。
方法：2016年1月至2020年12月期间，在单个脊柱中心接受诱发电位测试和手术治疗的102名连续患者，至少随访6个月。
方法：日本骨科协会（JOA）在手术前和手术后6个月获得的评分。
方法：本研究评估了术前中央运动传导时间（CMCT），体感诱发电位（SSEP），术前和术后6个月获得日本骨科协会（JOA）评分。
结果：在94例患者中观察到异常的CMCT表现（92.2％）。77例(75.5%)患者出现SSEP异常。术前JOA评分与短腿外展肌(APB)-CMCT之间有统计学意义的相关性(r=-0.546,p=0.000),胫骨前肌（TA）-CMCT（r=-0.517，p<=0.000），正中神经（MN）-SSEP（r=-0.353，p=0.001），和胫神经（TN）-SSEP（r=-0.349，p=0.003）。与糖尿病（DM）相关的康复率存在显着差异，术前脊髓病的严重程度，TA-CMCT,MN-SSEP,和TN-SSEP。逐步回归分析显示,影响临床结局的主要因素为TN-SSEP(β=0.327,p=0.004),术前JOA评分(β=0.278,p=0.012),和DM（β=0.241，p=0.025）。
结论：诱发电位测试是一种功能性诊断工具，可以指示DCM患者的脊髓病变症状的严重程度。此外,术前TN-SSEP在预测术后临床结局方面可能具有重要的预后价值。因此，术前诱发电位测试有助于确定合适的手术治疗方案和预测术后预后.
