2020 Fiscal Year Final Research Report
Intraoperative spinal cord monitoring waveform analysis and formulation of new alarm points for postoperative paralysis prevention
Project/Area Number |
18K16621
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Research Category |
Grant-in-Aid for Early-Career Scientists
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Allocation Type | Multi-year Fund |
Review Section |
Basic Section 56020:Orthopedics-related
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Research Institution | Nagoya University |
Principal Investigator |
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Project Period (FY) |
2018-04-01 – 2021-03-31
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Keywords | 脊椎手術 / 脊髄モニタリング / 多施設前向き研究 / 脊髄損傷 |
Outline of Final Research Achievements |
Tc-MEPs are widely used for IONM, but some cases have poor waveform derivation, even in multichannel Tc-MEP monitoring. The subjects were 3,625 patients who underwent Tc-MEP monitoring during spinal surgery at 16 spine centers between April 2017 and March 2020. Baseline Tc-MEPs were recorded from the deltoid, abductor pollicis brevis, adductor longus, quadriceps femoris, hamstrings, tibialis anterior, gastrocnemius, and abductor hallucis (AH) muscles after surgical exposure of the spine. The 3,625 cases included cervical, thoracic, and lumbar lesions (50%, 33% and 17%, respectively) and had preoperative motor status of no motor deficit, and motor deficit with MMT ≧3 and MMT <3. High-risk surgery was performed in 1,540 cases (43%). There were 73 cases with poor baseline waveform derivation (2%), and this was significantly associated with higher body weight, body mass index, thoracic lesions, motor deficit of MMT <3, high-risk surgery, and surgery for OPLL.
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Free Research Field |
医歯薬学
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Academic Significance and Societal Importance of the Research Achievements |
脊椎・脊髄手術は、危険な局面での手術が要求されることが多く、術中に生じる麻痺発生率も約2%と報告されている。一旦脊髄が損傷されるとその回復は極めて難しく、術後患者に与える肉体的、精神的、経済的負担は極めて大きい。故に、術中に脊髄損傷を未然に防ぐ安全な処置が望まれる。本研究成果の学術意義として、術中に波形が変化する中で、どのタイミングで手術の進行を止めるのかのアラームポイントが未だ一定ではないことであった。Tc-MEPにおける波形悪化の詳細な検討とアラームポイント策定は、臨床現場での予期せぬ術後麻痺を一例でも多く減らせうる一助になりうる可能性がある。
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