背景:术中神经生理学监测(IONM)是一种有助于评估脊柱手术过程中神经系统的技术。
方法:这是对描述IONM技术背后的基本机制的领域的回顾。这些包括最常用的经颅运动诱发电位(Tc-MEP),体感诱发电位(SSEP),刺激和自发的EMG活动。它还描述了有关从业人员的实践和资格的一些问题。
结果:尽管负责Tc-MEP和SSEP的解剖途径是众所周知的,并且这些临床技术具有很高的敏感性和特异性,几乎没有发表的数据表明监测实际上可以改善患者的预后。很明显,当受伤的风险很高时,IONM具有很高的效用,但是当受伤的风险非常低时,可能只会有轻微的帮助。监测小组必须训练有素,能够实时提供外科医生的反馈,并与手术和麻醉小组协调活动。
结论:尽管IONM是一种有价值的技术,可提供神经损伤的敏感和特定指征,它确实有必须理解的局限性。与受过适当培训的人员保持高质量的实践至关重要。
BACKGROUND: Intraoperative neurophysiologic monitoring (IONM) is a technique that is helpful for assessing the nervous system during spine surgery.
METHODS: This is a
review of the field describing the basic mechanisms behind the techniques of IONM. These include the most often utilized trancranial motor evoked potentials (Tc-MEPs), somatosensory evoked potentials (SSEPs), and stimulated and spontaneous EMG activity. It also describes some of the issues regarding practices and qualifications of practitioners.
RESULTS: Although the anatomic pathways responsible for the Tc-MEP and SSEP are well known and these clinical techniques have a high sensitivity and specificity, there is little published data showing that monitoring actually leads to improved patient outcomes. It is evident that IONM has high utility when the risk of injury is high, but may be only marginally helpful when the risk of injury is very low. The monitoring team must be well trained, be able to provide the surgeon feedback in real time, and coordinate activities with those of the surgical and anesthesia teams.
CONCLUSIONS: Although IONM is a valuable technique that provides sensitive and specific indications of neurologic injury, it does have limitations that must be understood. Maintaining a high quality of practice with appropriately trained personnel is critical.