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

doi:10.3969/j.issn.1006-5725.2025.18.017

Abstract

Abstract:

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 （D_max） and the ratio of MEP terminal amplitude change to the baseline at the end of the operation （D_end） 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 D_max and D_end 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 D_max and D_end. 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 D_end with the bilateral lower extremity motor function immediately after the operation in the cervical and thoracic groups were both greater than those of D_max， 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 D_end and D_max 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 D_end for the cervical group were 0.853 immediately after the operation and at 1 year， and the cut-off values of D_max were 0.881 and 0.978， respectively. For the thoracic group， the cut-off values of D_end were 0.532 immediately after the operation and 0.639 at 1 year， and the cut-off values of D_max 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， D_max should be emphasized to balance high sensitivity and specificity， while for the thoracic segment， D_max or D_end can be flexibly selected. Higher MEP warning thresholds are required for cervical OPLL surgery （D_max： 0.881 immediately after the operation and 0.978 at 1 year； D_end： 0.853）， while significantly lower thresholds are needed for thoracic OPLL （D_max/D_end： 0.532 immediately after the operation and 0.640 at 1 year）.

Key words: ossification of posterior longitudinal ligament, intraoperative neurophysiological monitoring, evoked potentials， motor, thoracic surgery, cervical spine

CLC Number:

R681.5

Li LI,Huan LI,Kai CHEN,Jia LIU,Wenwen SHEN,Yuqing WANG,Xiufang WU,Yushu BAI,Qiang LI,Jianmin LIU. 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[J]. The Journal of Practical Medicine, 2025, 41(18): 2898-2905.

Figures/Tables 5

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References 26

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项目	颈椎组	胸椎组	P值
病例数	186	41
性别			0.451
男	110（59.14）	21（51.22）
女	76（40.86）	20（48.78）
年龄（x ± s）/岁	59.5 ± 10.2	60.0 ± 10.1	0.387
病程（x ± s）/月	31.9 ± 17.14	16.24 ± 12.0	0.999
椎体节段数M（IQR）	3（1）	3（2）	0.572
双侧MEP基线诱发率	368（98.92）	79（96.34）	0.221
糖尿病史	28（15.05）	8（19.51）	0.479
手术时长M（IQR）/min	105（55）	120（80）	0.004
平均动脉压≤ 60 mmHg	14（0.08）	9（21.95）	0.006
估计出血量M（IQR）/L	0.11（0.15）	0.30（0.10）	< 0.001

时间	变量	AUC	95%CI	约登指数	cut-off值	灵敏度	特异度
术后即刻	颈椎D_max	0.987	0.964~1.000	0.926	0.881	0.929	0.997
	胸椎D_max	0.820	0.726~0.915	0.573	0.532	0.938	0.635
	颈椎D_end	0.939	0.900~0.884	0.566	0.853	0.929	0.955
	胸椎D_end	0.850	0.764~0.937	0.605	0.532	0.938	0.667
术后1年	颈椎D_max	0.998	0.995~1.000	0.994	0.978	1.000	0.994
	胸椎D_max	0.783	0.590~0.976	0.504	0.640	0.833	0.671
	颈椎D_end	0.954	0.933~0.975	0.944	0.853	1.000	0.944
	胸椎D_end	0.845	0.705~0.984	0.669	0.639	0.853	0.836

变量	OR（95%CI）	P值
性别	2.208（0.707 ~ 6.895）	0.173
年龄	0.992（0.937 ~ 1.050）	0.783
病程	0.952（0.895 ~ 1.011）	0.109
糖尿病	1.002（0.218 ~ 4.608）	0.998
手术方式	0.890（0.224 ~ 3.532）	0.868
手术时长	0.998（0.982 ~ 1.014）	0.788
平均动脉压	0.267（0.066 ~ 1.079）	0.064
估计出血量	1.005（1.000 ~ 1.010）	0.037
D_max	47.462（2.928 ~ 769.247）	0.007

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

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