Zusammenfassung
Die Korrektur von Halswirbelsäulendeformitäten ist mit einem nicht unerheblichen Risiko der neurologischen Verschlechterung verbunden. Ein intraoperatives Neuromonitoring (IOM) kann die Patientensicherheit in diesem Zusammenhang deutlich erhöhen. Allerdings ist die Datenlage bezüglich der Wirksamkeit in der rekonstruktiven HWS-Chirurgie beschränkt. Da das chirurgische Manöver in der rekonstruktiven HWS-Chirurgie mit den gleichen Risiken für das Rückenmark einhergeht wie die Skoliosekorrektur, ist von einem vergleichbaren Einfluss des IOM auf das klinische Ergebnis auszugehen. Für das IOM ist eine Senkung der Rate neurologischer Komplikationen im Rahmen der Skoliosechirurgie belegt. Im vorliegenden Beitrag wird die aktuelle Studienlage zur Wirksamkeit des IOM in der rekonstruktiven HWS-Chirurgie sowie in der Skoliosechirurgie erörtert.
Abstract
Correction of cervical deformity is associated with a considerable risk of neurological deterioration. The use of intraoperative neuromonitoring (IOM) can, however, significantly increase patient safety. Nonetheless, data on the effectiveness of IOM during reconstructive cervical surgery are very limited. Since the surgical maneuvers in reconstructive cervical surgery represent the same dangers to the spinal cord as in scoliosis correction, the same influence of IOM on the clinical outcome may be assumed. IOM has been shown to decrease the rate of neurological complications in scoliosis surgery. Herein, we discuss the current evidence for the efficacy of IOM during reconstructive cervical surgery as well as during scoliosis surgery.
Abbreviations
- EEG:
-
Elektroenzephalogram
- HWS:
-
Halswirbelsäule
- IOM:
-
Intraoperatives Neuromonitoring
- KI:
-
Konfidenzintervall
- MEP:
-
Motorisch evozierte Potenziale
- SSEP:
-
Somatosensorisch evozierte Potenziale
Literatur
Appel S, Korn A, Biron T, Goldstein K, Rand N, Millgram M, Floman Y, Ashkenazi E (2017) Efficacy of head repositioning in restoration of electrophysiological signals during cervical spine procedures. J Clin Neurophysiol 34:174–178
Ajiboye RM, Zoller SD, Sharma A, Mosich GM, Drysch A, Li J, Reza T, Pourtaheri S (2017) Intraoperative neuromonitoring for anterior cervical spine surgery: what is the evidence? Spine 42(1976):385–393
Bhagat S, Durst A, Grover H et al (2015) An evaluation of multimodal spinal cord monitoring in scoliosis surgery: a single centre experience of 354 operations. Eur Spine J 24:1399–1407
Belanger TA, Milam RAIV, Roh JS, Bohlman HH (2005) Cervicothoracic extension osteotomy for chin-on-chest deformity in ankylosing spondylitis. J Bone Joint Surg Am 87:1732–1738
Etame AB, Than KD, Wang AC, La Marca F, Park P (2008) Surgical management of symptomatic cervical or cervicothoracic kyphosis due to ankylosing spondylitis. Spine 33:E559–E564
Fehlings MG, Smith JS, Kopjar B et al (2012) Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. J Neurosurg Spine 16:425–432
Gavaret M, Trébuchon A, Aubert S et al (2011) Intraoperative monitoring in pediatric orthopedic spinal surgery: three hundred consecutive monitoring cases of which 10 % of patients were younger than 4 years of age. Spine 36:1855–1863
Gavaret M, Pesenti S, Choufani E et al (2016) Intraoperative spinal cord monitoring in children under 4 years old. Eur Spine J 25:1847–1854
Hamilton DK, Smith JS, Sansur CA, Glassman SD, Ames CP, Berven SH, Polly DW Jr, Perra JH, Knapp DR, Boachie-Adjei O, McCarthy RE, Shaffrey CI, Scoliosis Research Society Morbidity and Mortality Committee (2011) 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. Spine 36(1976):1218–1228
Hsu B, Cree AK, Lagopoulos J, Cummine JL (2008) Transcranial motor-evoked potentials combined with response recording through compound muscle action potential as the sole modality of spinal cord monitoring in spinal deformity surgery. Spine 33:1100–1106
Kim CH, Hong JT, Chung CK, Kim JY, Kim SM, Lee KW (2015) Intraoperative electrophysiological monitoring during posterior craniocervical distraction and realignment for congenital craniocervical anomaly. Eur Spine J. 24:671–678
Langeloo DD, Lelivelt A, Louis Journee H, Slappendel R, de Kleuver M (2003) Transcranial electrical motor-evoked potential monitoring during surgery for spinal deformity: a study of 145 patients. Spine 28:1043–1050
Langeloo DD, Journee HL, Pavlov PW, de Kleuver M (2006) Cervical osteotomy in ankylosing spondylitis: evaluation of new developments. Eur Spine J 15:493–500
Mummaneni PV, Dhall SS, Rodts GE, Haid RW (2008) Circumferential fusion for cervical kyphotic deformity. J Neurosurg Spine 9:515–521
Nottmeier EW, Deen HG, Patel N, Birch B (2009) Cervical kyphotic deformity correction using 360-degree reconstruction. J Spinal Disord Tech 22:385–391
O’Shaughnessy BA, Liu JC, Hsieh PC, Koski TR, Ganju A, Ondra SL (2008) Surgical treatment of fixed cervical kyphosis with myelopathy. Spine 33:771–778
Park P, Wang AC, Sangala JR, Kim SM, Hervey-Jumper S, Than KD, Farokhrani A, Lamarca F (2011) Impact of multimodal intraoperative monitoring during correction of symptomatic cervical or cervicothoracic kyphosis. J Neurosurg Spine 14:99–105
Plata Bello J, Pérez-Lorensu PJ, Roldán-Delgado H, Brage L, Rocha V, Hernández-Hernández V, Dóniz A, García-Marín V (2015) Role of multimodal intraoperative neurophysiological monitoring during positioning of patient prior to cervical spine surgery. Clin Neurophysiol 126:1264–1270
Peng X, Chen L, Wan Y, Zou X (2011) Treatment of primary basilar invagination by cervical traction and posterior instrumented reduction together with occipitocervical fusion. Spine 36:1528–1531
Shiban E, Meyer B, Stoffel M, Weinzierl M (2017) Intraoperatives neurophysiologisches Monitoring (IOM) in der Wirbelsäulenchirurgie. Wirbelsäule 1:203–218
Simmons ED, DiStefano RJ, Zheng Y, Simmons EH (2006) Thirty six years experience of cervical extension osteotomy in ankylosing spondylitis: techniques and outcomes. Spine 31:3006–3012
Sloan TB, Heyer EJ (2002) Anesthesia for intraoperative neurophysiologic monitoring of the spinal cord. J Clin Neurophysiol 19:430–443
Tobert DG, Glotzbecker MP, Hresko MT, Karlin LI, Proctor MR, Emans JB, Miller PE, Hedequist DJ (2017) Efficacy of Intraoperative Neurophysiologic Monitoring for Pediatric Cervical Spine Surgery. Spine 42:974–978
Traynelis VC, Abode-Iyamah KO, Leick KM, Bender SM, Greenlee JD (2012) Cervical decompression and reconstruction without intraoperative neurophysiological monitoring. J Neurosurg Spine 16:107–113
Thirumala PD, Huang J, Thiagarajan K, Cheng H, Balzer J, Crammond DJ (2016) Diagnostic accuracy of combined multimodality SSEP and TcMEP intraoperative monitoring in patients with idiopathic scoliosis. Spine 41:E1177–E1184
Thuet ED, Winscher JC, Padberg AM et al (2010) Validity and reliability of intraoperative monitoring in pediatric spinal deformity surgery: a 23-year experience of 3436 surgical cases. Spine 35:1880–1886
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
E. Shiban und B. Meyer geben an, dass keine Interessenkonflikte bestehen.
Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.
Rights and permissions
About this article
Cite this article
Shiban, E., Meyer, B. Intraoperatives Neuromonitoring in der rekonstruktiven Halswirbelsäulenchirurgie. Orthopäde 47, 526–529 (2018). https://doi.org/10.1007/s00132-018-3567-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00132-018-3567-y