收稿日期: 2025-04-25
网络出版日期: 2025-09-25
基金资助
上海市科技计划项目(23JS1400502)
Predictive effects of different motor evoked potential warning thresholds on motor function recovery following decompression for cervical and thoracic ossification of the posterior longitudinal ligament
Received date: 2025-04-25
Online published: 2025-09-25
目的 探讨运动诱发电位（MEP）在颈椎和胸椎两个不同节段的后纵韧带骨化（OPLL）减压手术中的最佳预警阈值，及不同MEP参数对术后下肢运动功能的预测作用。 方法 回顾性分析2022年1月至2024年1月在医院诊断为颈椎或胸椎OPLL且行减压手术的227例患者临床资料，男131例，女96例，年龄（60 ± 10）岁。术中所有患者均全程使用神经电生理监测，记录减压过程中MEP波幅变化的最小值与入室基线的比值Dmax，及减压结束后MEP终末波幅改变与入室基线的比值Dend，比较两个比值和术后即刻、1年下肢运动功能的相关性，根据医学研究理事会肌肉力量评分（MRC）标准，将术后评分结果与术前相比≥ 1分定义为术后运动功能障碍。应用Pearson相关系数评估Dmax和Dend与术后即刻、1年下肢运动功能相关性，绘制Dmax、Dend预测术后下肢运动功能障碍的受试者工作特征曲线（ROC曲线）。 结果 227例患者中，186例为颈椎OPLL，41例为胸椎OPLL。其中颈椎组在术后即刻、1年的下肢运动功能障碍发生例数分别为7例（3.76%）、2例（1.08%），胸椎组分别为9例（21.95%）、3例（7.32%），胸椎组下肢运动功能障碍的发生率高于颈椎组（P < 0.001）。颈椎组双侧下肢运动诱发电位的基线诱发率为98.92%（368/372），胸椎组为96.34%（79/82）。颈椎组和胸椎组的Dend与术后即刻双侧下肢运动功能情况的Pearson相关系数均大于Dmax，且差异有统计学意义（颈椎组r = 0.669、0.517，P = 0.001 2；胸椎组r = 0.882、0.727，P = 0.003 6），而颈椎组和胸椎组的Dend及Dmax与术后1年双侧下肢运动功能情况的Pearson相关系数的差异无统计学意义（颈椎组r = 0.457、0.352，P = 0.088；胸椎组r = 0.760、0.625，P = 0.098）。颈椎组在术后即刻及1年Dend 的cut-off值均为0.853，Dmax的cut-off值分别为0.881、0.978；胸椎组在术后即刻及1年Dend 的cut-off值分别为0.532、0.639，Dmax 的cut-off值分别为0.532、0.64。 结论 在OPLL手术中，MEP监测策略需根据手术节段调整，颈椎应侧重Dmax以平衡高灵敏度与特异度，而胸椎可灵活选用Dmax或Dend。颈椎OPLL术中需采用更高的MEP预警阈值（Dmax：术后即刻0.881、1年0.978；Dend：0.853），而胸椎OPLL的预警阈值则显著更低（Dmax/Dend：术后即刻0.532、1年0.640）。
李莉 , 李欢 , 陈凯 , 刘佳 , 沈文文 , 王雨晴 , 吴秀芳 , 白玉树 , 李强 , 刘建民 . 不同运动诱发电位预警标准对颈椎及胸椎节段的后纵韧带骨化减压术后运动功能的预测作用[J]. 实用医学杂志, 2025 , 41(18) : 2898 -2905 . DOI: 10.3969/j.issn.1006-5725.2025.18.017
Objective To explore the optimal warning threshold of motor evoked potentials （MEP） in decompression surgery for ossification of the posterior longitudinal ligament （OPLL） at cervical and thoracic segments， and the predictive role of different MEP parameters on postoperative lower extremity motor function. Methods A retrospective analysis was conducted on the clinical data of 227 patients diagnosed with cervical or thoracic OPLL and underwent decompression surgery from January 2022 to January 2024 in the hospital. There were 131 males and 96 females， with an average age of （60 ± 10） years. All patients underwent continuous neurophysiological monitoring during the operation， and the minimum ratio of MEP amplitude change to the baseline at the beginning of the operation （Dmax） and the ratio of MEP terminal amplitude change to the baseline at the end of the operation （Dend） were recorded. The correlations between these two ratios and the lower extremity motor function immediately after the operation and at 1 year were compared. According to the Medical Research Council muscle strength score （MRC） standard， a postoperative score increase of ≥1 point compared to preoperative was defined as postoperative motor dysfunction. Pearson correlation coefficients were used to evaluate the correlations between Dmax and Dend and the lower extremity motor function immediately after the operation and at 1 year. Receiver operating characteristic （ROC） curves were drawn to predict postoperative lower extremity motor dysfunction using Dmax and Dend. Results Among the 227 patients， 186 had cervical OPLL and 41 had thoracic OPLL. The incidence of lower extremity motor dysfunction immediately after the operation and at 1 year was 7 cases （3.76%） and 2 cases （1.08%） in the cervical group， and 9 cases （21.95%） and 3 cases （7.32%） in the thoracic group， respectively. The incidence of lower extremity motor dysfunction in the thoracic group was higher than that in the cervical group （P < 0.001）. The baseline induction rate of bilateral lower extremity MEPs was 98.92% （368/372） in the cervical group and 96.34% （79/82） in the thoracic group. The Pearson correlation coefficients of Dend with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of Dmax， and the differences were statistically significant （cervical group： r = 0.669， 0.517， P = 0.001 2； thoracic group： r = 0.882， 0.727， P = 0.003 6）， while the differences in the Pearson correlation coefficients of Dend and Dmax with the bilateral lower extremity motor function at 1 year were not statistically significant （cervical group： r = 0.457， 0.352， P = 0.088； thoracic group： r = 0.760， 0.625， P = 0.098）. The cut-off values of Dend for the cervical group were 0.853 immediately after the operation and at 1 year， and the cut-off values of Dmax were 0.881 and 0.978， respectively. For the thoracic group， the cut-off values of Dend were 0.532 immediately after the operation and 0.639 at 1 year， and the cut-off values of Dmax were 0.532 and 0.640， respectively. Conclusions In OPLL surgery， the MEP monitoring strategy should be adjusted according to the surgical segment. For the cervical segment， Dmax should be emphasized to balance high sensitivity and specificity， while for the thoracic segment， Dmax or Dend can be flexibly selected. Higher MEP warning thresholds are required for cervical OPLL surgery （Dmax： 0.881 immediately after the operation and 0.978 at 1 year； Dend： 0.853）， while significantly lower thresholds are needed for thoracic OPLL （Dmax/Dend： 0.532 immediately after the operation and 0.640 at 1 year）.
| [1] | FUJIMORI T， NAKAJIMA N， SUGIURA T， et al. Epidemiology of symptomatic ossification of the posterior longitudinal ligament： A nationwide registry survey［J］. J Spine Surg， 2021， 7（4）： 485-494. doi:10.21037/jss-21-78 |
| [2] | LE H V， WICK J B， VAN B W， et al. Ossification of the Posterior Longitudinal Ligament： Pathophysiology， Diagnosis， and Management［J］. J Am Acad Orthop Surg， 2022， 30（17）： 820-830. doi:10.5435/jaaos-d-22-00049 |
| [3] | 冯彦斌，郭召，安纪龙，等. 不同椎板开门角度对颈椎单开门微型钛板固定成形术患者术后轴性症状的影响［J］. 实用医学杂志，2021，37（18）：2407-2412. |
| [4] | YOSHIDA G， ANDO M， IMAGAMA S， et al. Alert Timing and Corresponding Intervention With Intraoperative Spinal Cord Monitoring for High-Risk Spinal Surgery［J］. Spine （Phila Pa 1976）， 2019， 44（8）： E470-E479. doi:10.1097/BRS.0000000000002900 |
| [5] | LI H， DAI L Y. A systematic review of complications in cervical spine surgery for ossification of the posterior longitudinal ligament［J］. Spine J， 2011， 11（11）： 1049-1057. doi:10.1016/j.spinee.2011.09.008 |
| [6] | IMAGAMA S， ANDO K， TAKEUCHI K， et al. Perioperative Complications After Surgery for Thoracic Ossification of Posterior Longitudinal Ligament： A Nationwide Multicenter Prospective Study［J］. Spine （Phila Pa 1976）， 2018， 43（23）： E1389-E1397. doi:10.1097/brs.0000000000002703 |
| [7] | 中国康复医学会脊柱脊髓专业委员会脊柱外科神经电生理学组，中国研究型医院学会临床神经电生理专业委员会，胡勇. 脊柱外科术中神经电生理监测临床实践指南［J］. 中国脊柱脊髓杂志，2024，34（9）：998-1008. |
| [8] | EPSTEIN N E， AGULNICK M A. Perspective： Triple intraoperative neurophysiological monitoring （IONM） should be considered the standard of care （SOC） for performing cervical surgery for ossification of the posterior longitudinal ligament （OPLL）［J］. Surg Neurol Int， 2023， 14： 336. doi:10.25259/sni_710_2023 |
| [9] | MCDEVITT W M， QUINN L， WIMALACHANDRA W S B， et al. Amplitude-reduction alert criteria and intervention during complex paediatric cervical spine surgery［J］. Clin Neurophysiol Pract， 2022， 7： 239-244. doi:10.1016/j.cnp.2022.07.003 |
| [10] | KOBAYASHI K， IMAGAMA S， YOSHIDA G， et al. Efficacy of Intraoperative Intervention Following Transcranial Motor-evoked Potentials Alert During Posterior Decompression and Fusion Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament： A Prospective Multicenter Study of the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research［J］. Spine （Phila Pa 1976）， 2021， 46（4）： 268-276. doi:10.1097/brs.0000000000003774 |
| [11] | HAMILTON D K， SMITH J S， SANSUR C A， et al. Rates of new neurological deficit associated with spine surgery based on 108，419 procedures： A report of the scoliosis research society morbidity and mortality committee［J］. Spine （Phila Pa 1976）， 2011， 36（15）： 1218-1228. doi:10.1097/brs.0b013e3181ec5fd9 |
| [12] | MATSUMOTO M， TOYAMA Y， CHIKUDA H， et al. Outcomes of fusion surgery for ossification of the posterior longitudinal ligament of the thoracic spine： A multicenter retrospective survey： Clinical article［J］. J Neurosurg Spine， 2011， 15（4）： 380-385. doi:10.3171/2011.6.spine10816 |
| [13] | AGARWAL N， SHABANI S， HUANG J， et al. Intraoperative Monitoring for Spinal Surgery［J］. Neurol Clin， 2022， 40（2）： 269-281. |
| [14] | SHIGEMATSU H， ANDO M， KOBAYASHI K， et al. Efficacy of D-Wave Monitoring Combined With the Transcranial Motor-Evoked Potentials in High-Risk Spinal Surgery： A Retrospective Multicenter Study of the Monitoring Committee of the Japanese Society for Spine Surgery and Related Research［J］. Global Spine J， 2023， 13（8）： 2387-2395. doi:10.1177/21925682221084649 |
| [15] | GUPTA S， SIDDIQUI S A， SINHA U， et al. Multimodal Intraoperative Neurophysiological Monitoring in Cranial and Spinal Tumour Surgeries： A Descriptive Observational Study［J］. Cureus， 2023， 15（11）： e49411. |
| [16] | REDDY R P， CHANG R， COUTINHO D V， et al. Triggered Electromyography is a Useful Intraoperative Adjunct to Predict Postoperative Neurological Deficit Following Lumbar Pedicle Screw Instrumentation［J］. Global Spine J， 2022， 12（5）： 1003-1011. doi:10.1177/21925682211018472 |
| [17] | LANGELOO D D， LELIVELT A， JOURNéE H L， et al. Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity： A study of 145 patients［J］. Spine （Phila Pa 1976）， 2003， 28（10）： 1043-1050. doi:10.1097/01.brs.0000061995.75709.78 |
| [18] | ALVI M A， KWON B K， HEJRATI N， et al. Accuracy of Intraoperative Neuromonitoring in the Diagnosis of Intraoperative Neurological Decline in the Setting of Spinal Surgery-A Systematic Review and Meta-Analysis［J］. Global Spine J， 2024， 14（）： 105S-149S. doi:10.1177/21925682231196514 |
| [19] | 周琳. 多种模式与单种模式神经电生理监测在重度颈椎后纵韧带骨化椎体次全切术中的对比研究［J］. 中国骨伤， 2019， 32（12）：1102-1107. |
| [20] | ANDO K， KOBAYASHI K， MACHINO M， et al. Wave changes in intraoperative transcranial motor-evoked potentials during posterior decompression and dekyphotic corrective fusion with instrumentation for thoracic ossification of the posterior longitudinal ligament［J］. Eur J Orthop Surg Traumatol， 2019， 29（6）： 1177-1185. doi:10.1007/s00590-019-02435-1 |
| [21] | HARAZEEN A， PATEL A， PATEL C. Spinal Cord Infarction as a Cause of Acute Myelopathy［J］. Cureus， 2023， 15（12）： e50379. |
| [22] | KIM J S， KIM H， HYUN S J， et al. Different cutoff value of motor evoked potentials for the postoperative outcome in the ossification of the posterior longitudinal ligament surgery in the cervical and thoracic spine［J］. Spine J， 2024， 24（4）： 572-581. doi:10.1016/j.spinee.2023.11.022 |
| [23] | 劳梦婷，杜荣苇，郑洲雪，等. 不同运动诱发电位状态脑卒中亚急性期患者单侧上肢训练中皮层反应的差异：一项基于fNIRS的研究［J］. 中华神经医学杂志，2025，24（5）：472-480. |
| [24] | MURAMOTO A， IMAGAMA S， ITO Z， et al. The cutoff amplitude of transcranial motor-evoked potentials for predicting postoperative motor deficits in thoracic spine surgery［J］. Spine （Phila Pa 1976）， 2013， 38（1）： E21-E27. doi:10.1097/brs.0b013e3182796b15 |
| [25] | DULFER S E， GROEN H， GROEN R J M， et al. The Association of Physiological and Pharmacological Anesthetic Parameters With Motor-Evoked Potentials： A Multivariable Longitudinal Mixed Model Analysis［J］. Anesth Analg， 2024， 139（3）： 609-616. doi:10.1213/ane.0000000000006757 |
| [26] | WILENT W B， TESDAHL E A， TROTT J T， et al. Impact of inhalational anesthetic agents on the baseline monitorability of motor evoked potentials during spine surgery： A review of 22，755 cervical and lumbar procedures［J］. Spine J， 2021， 21（11）： 1839-1846. doi:10.1016/j.spinee.2021.07.002 |
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