The Study Of Fusion Line’s Preliminary Application In Total Or Near-total Resection Of Spinal Cord Lipoma

PurposeThe purpose of this paper is to clarify the significance of Fusion line in total or near-total resection of spinal cord lipoma,and to examine the relationship between Fusion line and neurological function.Under the Intraoperative neurophysiological monitoring(IONM),the Fusion line was used as the dividing line between spinal cord and lipoma in total or near-total resection of spinal cord lipoma.It was used to evaluate the prognosis and neurological function of patients after operation,to reduce the recurrence rate and to improve the living quality of patients.MethodThis study collected data from8 patients who were diagnosed with spinal cord lipoma and would receive operative treatment of spinal cord lipoma in our hospital from January 2017 to December 2020.UsingMcCormick grading method to evaluate the patients’clinical neurological function.Intraoperative neurophysiological monitoring was used during the resection of spinal cord lipoma.The monitoring methods include somatosensory evoked potential(SSEP),Transcranial motor evoked potential(T-MEP)and electromyogram(EMG).8 sites on the Fusion line between spinal cord and lipoma were selected;the 8 sites are at the head;the tail and 1/4,1/2,3/4 place of the both sides are on the Fusion line.Giving a current stimulation the Fusion line and two sides’ spinal cord and lipoma.Recording the change of EMG.And detecting SSEP and T-MEP many times during the operation,and the changes of evoked threshold,amplitude and latency of sensory and motor evoked potentials were recorded during before and after of the resection of spinal lipoma.The patients would be followed up in every 3 months after the operation to record their symptoms by McCormick grading and to evaluate their surgical outcomes.ResultIn 8 cases,5 cases(100%)of dorsal spinal lipoma were completely removed,and 2 cases(66.7%)of the 3 cases of transitional spinal lipoma were completely removed.Each patient was selected 8 sites on the fusion line during the operation,and each site was tested for EMG at the spinal cord,fusion line and lipoma end respectively.Among the 192 measurements of 64 sites in 8 cases,67 cases(34.9%)had neurological function and 125 cases(65.1%)had no neurological function.The results of chi square analysis of fusion line and EMG showed that there was no significant difference between them(P=0.250).The results showed that the kappa value of the diagnostic test was 0.965.It can be suggested that fusion line is one of the reliable indexes for the demarcation line between spinal cord and lipoma.The results also showed the preoperative grade was higher than the postoperative grade(P=0.008),indicating when the Fusion line used as the dividing line between spinal cord and lipoma in total or near-total resection of spinal cord lipoma.It can be removed to the maximum extent to improve the neurological function of patients under the premise in protecting the nervous system.ConclusionThe Fusion linecan be used as the boundary of lipoma and spinal cord.It plays an important role in total or near-total resection ofspinal cord lipoma.It can hint the boundary of spinal cord lipoma for neurosurgeons,give effective protection for nerve function,reduce recurrence rate,and plays an important role in improving the effectivity of the prognosis and the quality of patients’ life.