| 제목 |
Risk factors analysis of change in IONM in patients with OPLL |
| 소속 |
Gangnam Severance Hospital, Department of Rehabilitation Medicine1, Yonsei University College of Medicine, Rehabilitation Institute of Neuromuscular Disease2 |
| 저자 |
Hyo Jeong Lee1,2*, Jinyoung Park1,2, Myungeun Yoo1,2, Yoon Ghil Park1,2† |
Introduction
Ossification of posterior longitudinal ligament (OPLL) can compress the spinal cord and lead to myelopathy, and intraoperative neurophysiologic monitoring (IONM) is being widely performed to prevent neurologic deterioration in OPLL surgery. To our knowledge, this is the first study that determine the risk factors in deteriorating intraoperative evoked potentials (ioEPs) or postoperative motor deterioration (PMD) in patients with OPLL who undergo surgery.
Methods
This study reviewed the data from 259 patients who underwent OPLL removal surgery under IONM in a tertiary hospital from February 2015 to July 2019. Subjects over an alarm criterion in somatosensory evoked potentials (SEPs) or motor evoked potentials (MEPs) were defined as deteriorated ioEP group. The alarm criteria of SEPs was defined as a reduction of amplitude > 50% and/or prolongation of latency > 10%. For the MEPs, the amplitude reduction > 50% was set as an alarm criteria. The PMD which persists until 4 weeks after surgery (persistent PMD) was considered as significant postoperative neurological sequelae.
Multivariate logistic regression was used to determine the risk factors for ioEP deterioration or for persistent PMD.
Results
Of 259 patients, 40 (15.4%) were classified to the deteriorated ioEP group, and 219 (84.6%) were classified to the stable ioEP group. The IONM data collected throughout surgery as perioperative factors, as well as demographic data, preoperative, and postoperative factors were identified (Table 1). Of the analyzed variables, only the estimated bleeding amount had significance in predicting the deterioration of ioEPs during OPLL surgery (odds ratio (OR), 1.8; 95% confidence interval (CI), 1.1-3.2; P = 0.026) (Table 2). The number of vertebral levels and the significant MEP change were analyzed as risk factors for persistent PMD (OR, 1.3; 95% CI, 1.0-1.7; P = 0.046; OR, 8.8; 95% CI, 3.0-25.4; P = < 0.001) (Table 3).
Conclusion
The only risk factor for ioEP deterioration during OPLL surgery was the bleeding amount. In addition, the number of vertebral levels and the significant MEP change were risk factors for persistent PMD in patients with OPLL removal surgery. During OPLL removal surgery, IONM including MEP would help yielding favorable clinical outcomes, and surgeons should pay attention to reduce the bleeding amount. |
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Table 1. Baseline characteristics and associated factors in patients with OPLL surgery
Table 2. Multivariate logistic regression analysis to find out the risk factors of deteriorated intraoperative evoked potential in patients with OPLL surgery
Table 3. Multivariate logistic regression analysis to find out the risk factors of persistent motor deterioration in patients with OPLL surgery
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