Analysis Of Application In Neurophysiologic Monitoring In Surgery Of Elder Lumbar Spinal Stenosis

Background In recent decades,the technique of intraoperative neurophysiologic monitoring(IONM)has developed rapidly and has become an indispensable part of neurosurgery,spinal surgery and hand-foot surgery.Correct use of IONM technology can largely avoid intraoperative nerve damage.The monitoring of Somatosensory Evoked Potential(SEP)in IONM can be used to judge the condition and severity of intraoperative spinal cord compression according to the changes of latency and amplitude.New spinal cord functional impairment after spinal surgery is one of the common postoperative complications of spinal surgery,which has a great impact on the postoperative quality of life of patients.Proper application of IONM technology can reduce or avoid intraoperative spinal cord or nerve root injury.Study design Prospective clinical study.Objective The use of SEP cooperate with preoperative and postoperative spinal nerve function with score,to evaluate the effect of decompression of the spinal decompression surgery,observe the change of SEP for the effect of decompression of the lumbar spinal stenosis or lumbar disc-herniation disease patients,and the use of Motor Evoked Potentials(MEP)and electromyography(EMG)in intraoperative protection of spinal cord,reduce the occurrence of complications such as postoperative neurologic deficits.Methods Thirty-eight patients with lumbar spinal stenosis or lumbar disc-herniation were included,and their intraoperative neurophysiologic monitoring was carried out during the operation to observe the latency of P40 and N50 sites of somatosensory evoked potential(SEP)and the changes of P40-N50 potential difference before and after decompression,and intraoperative neurophysiologic monitoring technology was used to ensure the safety of the operation.Results A total of 36 patients received satisfactory data.A total of 48 limbs were detected,and the P40 potential latency was 44.97±1.85 ms before decompression,and 45.46±1.38 ms after decompression.The latent period of N50 potential was 52.62±1.33 ms before decompression,and 52.87±1.34 ms after decompression.The p40-n50 potential difference was 0.85±0.18μV before and 0.89±0.15μV after decompression.During the operation,one patient showed abnormal electromyography and motor evoked potential.After adjustment,the waveform returned to normal,and the postoperative score showed good recovery.Conclusion The p40-n50 potential difference of somatosensory evoked potential(SEP)in the operative treatment of degenerative diseases in spinal surgery was changed during the decompression step,and the results were statistically significant.However,the specific mechanism and regularity of the change still need to be further explored.Intraoperative neurophysiologic monitoring can effectively detect the risk of intraoperative nerve injury and provide guarantee for patients to complete the operation safely.