The Application Of Neurophysiological In Minimally Invasive Spine Surgery

Objectives:To investigate the application of neurophysiological in minimally invasive spine surgery.Methods:A retrospective analysis was made on 37 patients with lumbar disc herniation between April 2014 to July 2014. There were 35 cases of lumbar disc herniation and 2 cases of lumbar disc herniation with spinal stenosis. Under local anesthesia, all patients underwent percutaneous endoscopic transforaminal lumbar discectomy(PELD), Intraoperative free-running electromyography(free-EMG)was used for monitoring nerve root function, as well as,record the subjective feeling(pain) of patients. In healthy people as controls, 100 cases of unilateral L5-S1 disc herniation from august 2014 to july 2015 were reviewed retrospectively. All patients underwent preoperative and postoperative H reflex, F-wave and motor nerve conduction velocity(MNCV) electrophysiological examination; analysis the sensitivity of H reflex and F-wave examination results in diagnosis. The results of H reflex, F-wave and MNCV was compared in Preoperative and postoperative.Results:in the process of operation channel placed, all patients appear the waist pain, free-running EMG has no obviously change; the free-EMG significant changes, but no pain in two patients; Leg pain and electrophysiological changes in 35 cases of obvious. Reminded surgeon, the leg pain of patients and the changes of neurophysiological monitoring disappeared after adjusting operation channel. In the discectomy, the free-EMG of all patients have no significant changes and no pain. When the nerve root decompression, free electricity for all patients Figure(free-EMG) are significant changes and leg pain, after stopping operation, leg pain disappeared and neurophysiological monitoring results are also returned to normal. Patients appeared significant EMG response and leg pain when stimulating the nerve root. H reflex and F wave abnormality rate was 87% and 69% respectively in preoperation. Preoperative and postoperative H reflex, F-wave latency compared,there was a significant statistically difference(P <0.05). Preoperative H reflex, F wave latency compared with health people group have significant statistical difference(P<0.05). Postoperative H reflex, F wave latency compared with health people group have no significant statistical difference(P>0.05);Preoperative ipsilateral H reflex, F wave latency compared with the contralateral have significant statistical difference(P<0.05). Postoperative ipsilateral H reflex, F wave latency compared with the contralateral have no significant statistical difference(P>0.05). Preoperative contralateral H reflex, F wave latency compared with the healthy control group have no significant statistical difference(P>0.05). The motor nerve conduction velocity of tibial nerve compared with the healthy group had no statistically significant difference(P> 0.05).Conclusions:Intraoperative free running EMG monitoring can improve surgical safety. H reflex,F-wave has the significant clinical value on the diagnosis of lumbosacral radiculopathy and evaluating the surgery.