目的:描述触发肌电图(T-EMG)在术中神经生理监测中的原理和应用,探讨多模式术中神经电生理监测(IOM)下后路经皮神经内镜下颈椎髓核摘除术(PPECD)治疗神经根型颈椎病(CSR)的疗效及安全性。
方法:本研究为回顾性队列对照研究。回顾性分析2015年6月至2018年8月74例单节段CSR患者的临床资料,其中35人接受了IOM辅助的PPECD并触发了EMG(T-EMG组),39例患者仅接受了IOM辅助的PPECD(IOM组)。操作时间,住院,记录两组的并发症。根据颈部和手臂疼痛的视觉模拟量表(VAS)评估疗效。日本骨科协会(JOA)评分,并修改了MacNab量表。
结果:手术成功,所有患者随访至少24(平均31.77±9.51)个月,无患者失访。T-EMG组与IOM组术前基线资料比较差异无统计学意义(P>0.05)。此外,T-EMG(108.29±11.44min)与IOM(110.13±12.70min)组手术时间差异无统计学意义(P>0.05),住院时间(T-EMG:5.66±0.99天;IOM:7.10±1.43天)差异有统计学意义(P<0.05)。术后1个月,两组颈部和上肢的VAS(T-EMG:2.09±1.07,2.26±0.92;IOM:2.18±1.05,2.31±0.77)和末次随访(T-EMG:0.83±0.62,0.86±0.55;IOM:0.90±0.50,0.87±0.61)与术前评分(T-1.28±0.17,IOG:1.18±然而,两组比较差异无统计学意义(P>0.05)。两组术后1个月JOA评分(12.69±0.76;12.59±0.82)和末次随访时(14.60±0.77;14.36±0.78)与术前评分(11.09±0.98;11.05±0.89)比较,差异有统计学意义(P<0.05),但两组间差异无统计学意义(P>0.05)。T-EMG组中的一名患者在手术后的第一天出现了短暂的症状加重。在国际移民组织中,3例患者术中出现脑脊液漏,4例患者术后出现C5神经根麻痹症状。与国际移民组织相比,T-EMG组并发症较少(1/35;7/39,P<0.05)。在最后一次随访中,T-EMG组和IOM组的改良MacNab标准分别为91.43%(32/35)和89.7%(35/39),分别。
结论:触发肌电图可预防神经系统并发症的发生,这不仅有助于PPECD用于CSR治疗取得令人满意的效果,但也降低了平均住院时间和并发症发生率。
OBJECTIVE: To describe the rationale and application of triggered EMG (T-EMG) in intraoperative neurophysiological monitoring, and to explore the efficacy and safety of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy (CSR) under multimodal intraoperative neurophysiological monitoring (IOM).
METHODS: This study was a retrospective cohort control study. The clinical data of 74 patients with single-segment CSR from June 2015 to August 2018 were analyzed retrospectively, of whom 35 underwent IOM-assisted PPECD with triggered EMG (T-EMG group), while 39 were subjected to IOM-assisted PPECD alone (IOM group). Operation time, hospital stay, and complications were recorded for both groups. The curative effect was evaluated according to the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) score, and modified MacNab scale.
RESULTS: Operations were successful and all patients were followed up for at least 24 (average 31.77 ± 9.51) months with no patient lost to follow-up. No significant difference was found in preoperative baseline data between the T-EMG and the IOM group (P > 0.05). Also, no significant difference was found in the operation time between the T-EMG (108.29 ± 11.44 min) and the IOM (110.13 ± 12.70 min) (P > 0.05) group, but the difference in hospital stay (T-EMG: 5.66 ± 0.99 days; IOM: 7.10 ± 1.43 days) was statistically significant (P < 0.05). The VAS for the neck and upper limbs in the two groups at 1 month post-operation (T-EMG: 2.09 ± 1.07, 2.26 ± 0.92; IOM:2.18 ± 1.05, 2.31 ± 0.77) and the last follow-up (T-EMG: 0.83 ± 0.62, 0.86 ± 0.55; IOM: 0.90 ± 0.50, 0.87 ± 0.61) were significantly different from the preoperative scores (T-EMG: 6.14 ± 1.09, 7.17 ± 1.04; IOM: 6.18 ± 1.28, 7.15 ± 1.23) (P < 0.05). However, no significant difference was found between the two groups (P > 0.05). The 1-month postoperative JOA scores for the two groups (12.69 ± 0.76; 12.59 ± 0.82) and those at the last follow-up (14.60 ± 0.77; 14.36 ± 0.78) were significantly different from the preoperative scores (11.09 ± 0.98; 11.05 ± 0.89) (P < 0.05), but the difference between the two groups was not significant (P > 0.05). One patient in the T-EMG group developed a transient aggravation of symptoms on the first day after surgery. In the IOM group, three patients had intraoperative cerebrospinal fluid leakage, and symptoms of C5 nerve root paralysis were presented in four patients following surgery. Compared with the IOM group, the T-EMG group had fewer complications (1/35; 7/39, P < 0.05). At the last follow-up, the modified MacNab criteria were 91.43% (32/35) and 89.7% (35/39) for the T-EMG group and IOM group, respectively.
CONCLUSIONS: Triggered EMG prevents the occurrence of neurological complications, which not only aids PPECD for CSR treatment in achieving satisfactory results, but also reduces average hospital stay and complication rates.