Abstract

Objective

To analyse the intra-operative neurophysiological monitoring (IONM) data in patients with dystrophic neurofibromatosis type 1 (NF1) associated scoliosis, and to investigate the possible risk factors for failed IONM monitoring.

Methods

Patients undergoing posterior spinal fusion from September 2015 to December 2019 were retrospectively reviewed. The latency (P37, N50) and amplitude of somatosensory evoked potentials (SEP) in bilateral lower extremities, latency and amplitude of motor evoked potentials (MEP) in bilateral lower extremities and unilateral upper extremity were recorded. The neurological status, curve pattern, Cobb angle of main curve, vertebral rotatory subluxation and dystrophic features at pre-operation were assessed for each patient. The failed IONM monitoring was defined as no reliable SEP or MEP waveforms of all monitored muscles.

Results

A total of 92 patients (53 M, 39 F) with an average age of 14.1 ± 2.7 years were included. Failed IONM monitoring was identified in 17 patients with overall success rates being 87.0 and 94.6% for SEP and MEP. The average P37 latency, N50 latency, SEP amplitude and MEP latency showed no significant difference between concave and convex sides (p > 0.05 for all). The MEP amplitudes of lower extremities were lower on concave side than convex side (334.5 ± 291.9 µV VS 417.5 ± 380.5 µV, p = 0.030). Higher risk of failed IONM monitoring was found in patients with neurological deficit (p = 0.014) and more dystrophic features (p = 0.002) at pre-operation.

Conclusions

The overall success rates were 87.0% for SEP and 94.6% for MEP in patients with NF1-associated scoliosis. Neurological deficit and more dystrophic features at pre-operation indicated higher risk of failed IONM monitoring.

中文翻译：

---

营养不良性神经纤维瘤病 1 型脊柱侧弯患者的术中神经生理监测

摘要

客观的

分析 1 型营养不良性神经纤维瘤病 (NF1) 相关脊柱侧凸患者的术中神经生理监测 (IONM) 数据，并探讨 IONM 监测失败的可能危险因素。

方法

回顾性分析了 2015 年 9 月至 2019 年 12 月接受后路脊柱融合术的患者。记录双侧下肢体感诱发电位（SEP）潜伏期（P37，N50）和幅度，双下肢和单侧上肢运动诱发电位（MEP）潜伏期和幅度。评估每位患者术前的神经系统状态、曲线模式、主曲线Cobb角、椎体旋转半脱位和营养不良特征。失败的 IONM 监测被定义为所有监测肌肉没有可靠的 SEP 或 MEP 波形。

结果

共包括 92 名平均年龄为 14.1 ± 2.7 岁的患者 (53 M, 39 F)。17 名患者的 IONM 监测失败，SEP 和 MEP 的总体成功率为 87.0% 和 94.6%。平均 P37 潜伏期、N50 潜伏期、SEP 幅度和 MEP 潜伏期在凹面和凸面之间没有显着差异（p  > 0.05）。下肢的 MEP 振幅在凹侧低于凸侧 (334.5 ± 291.9 µV VS 417.5 ± 380.5 µV, p  = 0.030)。在术前有神经功能缺损 ( p  = 0.014) 和更多营养不良特征 ( p  = 0.002) 的患者中发现 IONM 监测失败的风险较高。

结论

在 NF1 相关脊柱侧弯患者中，SEP 的总体成功率为 87.0%，MEP 的总体成功率为 94.6%。术前神经功能缺损和更多营养不良特征表明 IONM 监测失败的风险较高。