髓内MRI信号异常的脊髓型颈椎病患者术中神经电生理的变化及其意义

doi:10.3969/j.issn.1671-7171.2022.03.03

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摘要【目的】探讨核磁共振成像(Magnetic Resonance Imaging,MRI)异常信号的脊髓型颈椎病(Cervical Spondylotic Myelopathy,CSM)患者术中神经电生理监测(Intraoperative Neurophysiological Monitoring,IONM)指标,运动诱发电位(Motor Evoked Potentials,MEPs)和体感诱发电位作(Somatosensory Evoked Potentials, SEPs)的变化,分析异常MRI信号与IONM变化的关系。【方法】共收集本院2019年1月至2021年1月150例异常MRI信号的CSM患者临床及IONM数据,根据其信号特征分为两组。A组:T₂WIs高信号(120例);B组:T₂WIs高信号同时T₁WIs低信号(30例)。记录手术重要节点的IONM数据。【结果】A组:9例IONM改变,1例暂时性神经损伤,无新发永久神经损伤;B组:18例IONM改变,5例暂时性神经损伤,2例新发永久性神经损伤。两组间IONM改变差异有统计学意义(MEPs, 5/120 vs 12/30,P<0.05; SEPs, 4/120 vs 6/30,P<0.05)。此外,B组减压前后IONM波幅存在差异有统计学意义[MEPs,(134±30.2)μV vs (65±26.2)μV, P<0.05;SEPs,(2.4±0.9)μV vs (1.3±0.7)μV,P<0.05]。【结论】CSM患者T₂WIs高信号同时T₁WIs低信号比单独T₂WIs高信号更易出现IONM改变,从而导致神经损伤的发生。在CSM脊髓减压过程中要注意IONM改变,必要时需要采取适当的手术干预措施。

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	林向全
	郑忠
	林勤
	李超雄

关键词 ：脊髓疾病/并发症, 颈椎病/外科学, 磁共振成像

Abstract：【Objective】To investigate the changes of intraoperative neuroelectrophysiological monitoring (IONM) indexes, motor evoked potentials (MEPs) and somatosensory evoked potentials (SEPs) in patients with cervical spondylotic myelopathy (CSM) with abnormal MRI signals, and to analyze the relationship between abnormal MRI signals and IONM changes.【Methods】The clinical and IONM data of 150 CSM patients with abnormal MRI signals from January 2019 to January 2021 were collected and divided into two groups according to their signal characteristics. Group A: T₂WIs high signal (120 cases); Group B: T₂WIs high signal and T₁WIs low signal (30 cases). The IONM data of important surgical nodes were recorded. 【Results】 Group A: 9 cases had IONM changes, 1 case had temporary nerve injury, and there was no new permanent nerve injury; Group B: 18 cases of IONM changes, 5 cases of temporary nerve injury and 2 cases of new permanent nerve injury. There was significant difference in IONM between the two groups (MEPs, 5/120 vs 12/30,P<0.05; SEPs, 4/120 vs 6/30,P<0.05). In addition, there was significant difference in IONM amplitude before and after decompression in the group B [MEPs,(134±30.2) μV vs (65±26.2) μV, P<0.05;SEPs, (2.4±0.9) μV vs (1.3±0.7) μV, P<0.05].【Conclusion】In CSM patients, high T₂WIs signal and low T₁WIs signal are more prone to IONM changes than high T₂WIs signal alone, resulting in nerve injury. In the process of CSM spinal cord decompression, we should pay attention to the changes of IONM, and take appropriate surgical intervention measures when necessary.

Key words： Spinal Cord Diseases/CO CERVICAL SPONDYLOSIS/SU Magnetic Resonance Imaging

收稿日期: 2022-02-16

中图分类号:

R274

基金资助:福建省自然科学基金面上项目(2019J01548)

通讯作者: ** E-mail:E-mail:lichaox0591@163.com

引用本文:

林向全, 郑忠, 林勤, 李超雄. 髓内MRI信号异常的脊髓型颈椎病患者术中神经电生理的变化及其意义[J]. 医学临床研究, 2022, 39(3): 328-331.
LIN Xiang-quan, ZHENG Zhong, LIN Qin, et al. Changes and Significance of Intraoperative Neurophysiology in Patients with Cervical Spondylotic Myelopathy with Abnormal Intramedullary MRI Signal. JOURNAL OF CLINICAL RESEARCH, 2022, 39(3): 328-331.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.03.03 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I3/328

[1] FUNABA M, KANCHIKU T, YOSHIDA G, et al. Efficacy of intraoperative neuromonitoring using transcranial motor-evoked potentials for degenerative cervical myelopathy: a prospective multicenter study by the monitoring committee of the japanese society for spine surgery and related research[J].Spine,2022, 47(1): E27-E37.
[2] WANG S, ZHANG J, TIAN Y, et al. Intraoperative motor evoked potential monitoring to patients with preoperative spinal deficits: judging its feasibility and analyzing the significance of rapid signal loss [J].Spine J, 2017, 17(6): 777-783.
[3] WANG S, TIAN Y, WANG C, et al. Prognostic value of intraoperative MEP signal improvement during surgical treatment of cervical compressive myelopathy [J].Eur Spine J,2016, 25(6): 1875-1880.
[4] NOURI A, TETREAULT L, ZAMORANO J J, et al. Role of magnetic resonance imaging in predicting surgical outcome in patients with cervical spondylotic myelopathy [J].Spine,2015, 40(3): 171-178.
[5] TAKAHASHI J, HIRABAYASHI H, HASHIDATE H, et al. Assessment of cervical myelopathy using transcranial magnetic stimulation and prediction of prognosis after laminoplasty [J].Spine,2008, 33(1): E15-E20.
[6] WADA E, YONENOBU K, SUZUKI S, et al. Can intramedullary signal change on magnetic resonance imaging predict surgical outcome in cervical spondylotic myelopathy? [J].Spine,1999, 24(5): 455-461.
[7] MORIO Y, TESHIMA R, NAGASHIMA H, et al. Correlation between operative outcomes of cervical compression myelopathy and MRI of the spinal cord [J].Spine,2001, 26(11): 1238-1245.
[8] PARKE W W. Correlative anatomy of cervical spondylotic myelopathy [J].Spine,1988, 13(7): 831-837.
[9] AL-MEFTY O, HARKEY L H, MIDDLETON T H, et al. Myelopathic cervical spondylotic lesions demonstrated by magnetic resonance imaging [J].J Neurosurg,1988, 68(2): 217-222.
[10] TETREAULT L A, DETTORI J R, WILSON J R, et al. Systematic review of magnetic resonance imaging characteristics that affect treatment decision making and predict clinical outcome in patients with cervical spondylotic myelopathy [J].Spine,2013, 38(22): S89-S110.
[11] ZHANG J T, MENG F T, WANG S, et al. Predictors of surgical outcome in cervical spondylotic myelopathy: focusing on the quantitative signal intensity [J].Eur Spine J,2015, 24(12): 2941-2945.