고위험 척추 수술에서 운동유발 전위 검사의 이용과 이를 통한 수술 중 신경학적 이상 발생의 원인에 대한 분석 = Analysis of Intraoperative Neurological Complications in High-Risk Spinal Surgery with the Use of Motor Evoked Potential Monitoring

다국어 초록 (Multilingual Abstract)

Study Design: This is retrospective study.
Objectives: To evaluate the risk of operative techniques using Motor Evoked Potential (MEP) in high-risk spinal surgery.
Summary of Literature Review: There are few studies regarding the evaluation of operative techniques by MEP.
Materials and Methods: We studied 33 cases that had MEP during surgery from July 2007 to March 2009. Diagnoses included posttraumatic kyphosis (PTK) in eight cases, congenital deformity in eight cases, degenerative lumbar deformity in eight cases, ankylosing spondylitis (AS) in three cases, spinal tumor in three cases, adjacent segmental disease in two cases, and post-surgical kyphosis in one case. Posterior vertebral column resection (PVCR) and pedicle subtraction osteotomy (PSO) were performed in 27 cases (81.8%) and, in the others, posterior decompression with discectomy was performed. We analyzed the risk of operative techniques and evaluated the MEP.
Results: MEP showed abnormal signal change in five cases (PVCR: one case, compression and distraction: four cases). The AS case did not demonstrate neurological change after surgery. Though the PTK on T12 operated by PVCR case did not show an abnormal MEP result,neurological change was observed postoperatively. The sensitivity, specificity, percent of false negatives, and percent of false positives of MEP were 80.0%, 96.4%, 20.0%, and 3.6%, respectively.
Conclusions: MEP monitoring is a useful method to detect neurological injury during high-risk spinal surgery with satisfactory specificity. For low sensitivity and a high false negative rate, increased monitoring of cases and continuous follow-up is needed. In conclusion, compression and distraction and PVCR are high-risk techniques in kyphotic deformity correction.
Key Words: High-risk Spinal surgery, Motor Evoked Potential (MEP), Operative technique, Neurological complication

국문 초록 (Abstract)

연구 계획: 고위험 척추 수술 시 신경학적 이상을 일으키는 수술 술식에 대하여 운동 유발 전위 검사를 통한 후향적인 연구를 시행.
목적: 신경학적 이상 소견이 발생할 가능성이 높은 고위험 척추 수술에서 수술 중 운동 유발 전위 검사(MEP)를 시행하여 수술 술기에 따른 위험도를 분석, 평가하고자 하였다.
선행문헌의 요약: 운동 유발 전위 검사를 이용하여 고위험 수술 시 신경학적 이상을 야기하는 수술 술식과 각 술식의 위험도에 관한 연구가 부족하였다.
대상 및 방법: 2007년 7월부터 2009년 3월까지 후방 척추 수술 중 신경감시로 MEP를 시행하였던 33명의 환자를 조사하였다. 원인 질환은 선천성 변형8명, 퇴행성 요추 변형 7명, 척추 골절 후 발생한 지연성 후만증(PTK) 8명, 강직성 척추염 3명, 척추 종양 3명, 수술 후 인접 부위 질환 3명, 수술 후 후만증 1명이었다. 후방 척추체 전 절제술(PVCR)과 척추경 제거 절골술(PSO)을 27례(81.8%)에서 시행하였고, 나머지 6례에서 후방 감압술 및 추간판 절제술만 시행하였다. 수술 중 시행한 MEP 결과와 수술 직후 신경학적 소견의 변화를 확인하여 MEP의 정확성과 수술 술기의 위험도에 대한 분석을 시행하였다.
결과: 수술 중 MEP에서 양성으로 이상 소견을 보인 경우는 5례(후방 척추체 전 절제술 직후 1례, 절골술 후 압박 신연 조작 직후 4례)이었다. 이중 강직성 척추염에 대하여 요추 3번에 PVCR 시행후 압박 신연 조작 직후 검사상 이상 소견이 발생한 1례에서는 수술 후 신경학적 이상 소견이 보이지 않았으나, PTK에 대하여 흉추 12번에 PVCR을 시행한 1례에서 수술 중 검사에서 정상 소견을 보였으나 수술 후 신경학적 이상 소견이 관찰되었다. MEP의 민감도는 80%, 특이도는 96.4%, 위음성률은 20%, 위양성률은 3.6%로 측정되었다.
결론: 고위험 척추 수술 중에 시행된 MEP는 만족할 만한 특이도를 보여주는 유용한 검사이나 낮게 측정된 민감도 및 높은 위음성률에 대해 계속적인검사 및 추시가 필요하며, 후만 변형의 교정을 위한 수술 시 절골술 후 압박 신연 조작과 후방 척추 전 절제 시 신경학적 이상 발생이 높음을 확인하였다.
색인 단어: 고위험 척추 수술, 운동 유발 전위 검사, 수술 술기, 신경학적 이상약칭 제목: 척추 수술 시 운동유발 전위 검사 시행

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