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Transcranial electrical stimulation as predictor of elicitation of intraoperative muscle-evoked potentials.

机译：经颅电刺激作为术中诱发肌肉诱发电位的预测因子。

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STUDY DESIGN: Preoperative electrophysiological and neurologic findings from patients with cervical myelopathy were evaluated statistically to determine their predictive value relative to the success of eliciting intraoperative motor-evoked potentials. OBJECTIVES: To determine which preoperative variables accurately predicted the success of eliciting an intraoperative muscle-evoked potential. SUMMARY OF BACKGROUND DATA: Motor-evoked potential recorded from the muscles after transcranial electrical stimulation is one of the most widely used methods for intraoperative spinal cord monitoring. However, motor-evoked potentials recorded from lower limb muscles are not detectable in patients with severe cervical myelopathy. Therefore, it is helpful to know the probability of the intraoperative transcranial electrical stimulation-motor evoked potential elicitation before the operation. METHODS: There were 38 patients with cervical myelopathy. Before the operation, motor-evoked potentials following transcranialmagnetic stimulation were recorded from the flexor hallucis brevis, and central motor conduction times were measured. Neurologic function was evaluated using the Japanese Orthopedic Association score. During the operation, transcranial electrical stimulation-motor evoked potential from the flexor hallucis brevis was recorded. The Japanese Orthopedic Association score, threshold intensity of magnetic stimulation, and central motor conduction times were statistically evaluated for their potential of being predictors. RESULTS: The intraoperative transcranial electrical stimulation-motor evoked potential was detectable in all cases in which the preoperative transcranial magnetic stimulation-motor evoked potential was elicited by a lower intensity than 50% of the maximum output of the stimulator. Therefore, simultaneous use of other methods of monitoring should be considered in such cases that need higher output. However, the Japanese Orthopedic Association score or central motor conduction times were not useful criteria. CONCLUSIONS.: The threshold intensity of the preoperative transcranial magnetic stimulation-motor evoked potential was helpful in predicting elicitation of the intraoperative transcranial electrical stimulation-motor evoked potential.
机译：研究设计：对来自颈脊髓病患者的术前电生理和神经学发现进行统计学评估，以确定其相对于成功诱发术中运动诱发电位的预测价值。目的：确定哪些术前变量能够准确预测诱发术中肌肉诱发电位的成功率。背景数据摘要：经颅电刺激后从肌肉记录的运动诱发电位是术中监测脊髓使用最广泛的方法之一。然而，在患有严重宫颈脊髓病的患者中无法检测到下肢肌肉记录的运动诱发电位。因此，有助于在术前了解术中经颅电刺激运动诱发电位的可能性。方法：38例颈椎病患者。手术前，从短屈肌幻觉记录经颅磁刺激后的电机诱发电位，并测量中心电机传导时间。使用日本骨科协会评分评估神经功能。手术期间，记录了来自短屈肌幻觉的经颅电刺激运动诱发电位。对日本骨科学会的评分，磁刺激的阈值强度和中枢运动传导时间进行了统计学评估，以评估其可能的预测能力。结果：在所有情况下，术前经颅磁刺激运动诱发电位的强度低于刺激器最大输出的50％时，均可检测到术中经颅神经刺激运动诱发电位。因此，在需要更高输出的情况下，应考虑同时使用其他监视方法。但是，日本骨科协会评分或中心运动传导时间不是有用的标准。结论：术前经颅磁刺激运动诱发电位的阈值强度有助于预测术中经颅电刺激运动诱发电位的诱发。

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