The Clinical Application Of Intraoperative Neuroelectrophysiological Monitoring In The Operation Of Degenerative Lumbar Spinal Stenosis

Objective:to explore the value of posterior spinal canal decompression and fusion internal fixation with neurophysiological monitoring in the treatment of degenerative lumbar spinal stenosis.Method:a retrospective analysis of cases.160 patients were treated with lumbar posterior spinal canal decompression,bone graft fusion and internal fixation in our hospital.Include 89 patients were monitored by electrophysiological monitoring as a monitoring group,and 71 cases without the Electrophysiological monitoring as control group.In the monitoring group,during the process of spinal canal decompression,bone grafting,fusion and internal fixation,the functional status of spinal cones and cauda equina was monitored by somatosensory evoked potential and motor evoked potential,and the function of spinal nerve root was monitored by free electromyography..The JOA scores and VAS pain scores before and after operation were compared between the two groups.The intraoperative electrophysiological data and related clinical data were recorded,and the sensitivity,specificity,false positive rate and false negative rate of nerve electrophysiological monitoring were calculated.The related factors of false positive and false negative were observed during the intraoperative neuroelectrophysiological monitoring.Results:In the monitoring group,during the process of posterior spinal canal decompression,bone graft and internal fixation.There are 24 cases of neurophysiological monitoring and early warning,2 cases of nerve function injury after operation,1 cases of anterolateral leg numbness of calf and 1 cases of lateral thigh pain.After operation,there were 6 cases of nerve function injury,of which 4 cases were anterolateral leg numbness and 2 cases were lateral thigh pain in the control group.The sensitivity of SEP monitoring was 75% and the specificity was 97.64%;the sensitivity of MEP monitoring was 91.66% and the specificity was 94.80%;the sensitivity of EMG monitoring was 100% and the specificity was 93.24% during the operation.The sensitivity of SEP+MEP+ spontaneous EMG combined monitoring was 100%,the specificity was 86.30%,the false negative rate was 0%,and the false positive rate was 27.5% during the operation.The mean value of JOA and VAS scores in the patients in the monitoring group was 7.86 ±1.40 and 8.06 ± 0.78 before operation.After operation,the mean value of 1 week later score was 23.16 ±2.11 and 2.43 ± 0.63,and the average score of 3 months later was 25.87 ± 1.38 and 1.06 ±0.53.The mean JOA and VAS scores in the control group were 7.92 ± 1.38,8.14 ± 0.76 before operation,and the mean scores was 19.23 ± 1.55,2.69 ± 0.64 after operation 1 week later.And 3 months later the mean value scores was 21.68±1.41 and 1.41±0.52.There was no significant difference between the monitoring group and the control group in the preoperative JOA and VAS scores(P > 0.05).However,there was a significant difference in postoperative scores between the two groups(P < 0.05).Conclusion: 1.The use of intraoperative nerve electrophysiological monitoring in posterior spinal canal decompression,bone grafting and internal fixation can reduce the risk of nerve injury,reduce the occurrence of nerve complications,ensure the safety of the operation and improve the curative effect.2.The application of intraoperative electrophysiologic monitoring in posterior spinal canal decompression and bone grafting and internal fixation has certain sensitivity and specificity.3.Intraoperative nerve electrophysiological monitoring has a certain safety monitoring function during operation,which has certain guiding significance for the operation of junior doctors.