부산대학교 도서관

Background Context: Somatosensory evoked potentials (SSEPs) are effective in detecting upper extremity positional injuries; however, causal factors for which patient population is most at risk are not well established.Purpose: To review causal factors for intraoperative SSEP changes due to patient positioning.Study Design: A case series with retrospective chart analysis was performed.Patient Sample: 398 patient charts and intraoperative neurophysiological monitoring data from patients who underwent thoracolumbar and lumbosacral spine surgery were reviewed in a consecutive sequence from 2012 to 2013.Outcome Measures: Adverse events (AE) with the upper extremity SSEP recordings were compared to the independent variables, sex, positioning, length of procedure, and body habitus.Methods: Thoracolumbar and lumbosacral spine surgeries using contemporaneous ulnar and median nerve SSEPs were reviewed. The one-way analysis of variance (ANOVA) test, Chi-square, and independent samples t test were used to determine statistical significance in having an upper extremity SSEP AE to the aforementioned independent variables.Results: The sample consisted of 209 males (52.5 %) and 189 females (47.5 %) (n = 398). AE to the upper extremity SSEP was seen in 44 patients. Sex was found to be statistically significant for isolated ulnar nerve AE (P ≤ 0.001) with males being most at risk (87.5 %). AE for isolated median nerve SSEP was statistically significant for supine and prone positions (P = 0.043). Length of procedure was statically significant for isolated ulnar nerve SSEP AE (P = 0.039). BMI was statistically significant for generalized upper extremity SSEP AE (P = 0.016), as well as isolated ulnar SSEP AE (P = 0.006), isolated median SSEP AE (P ≤ 0.001) and contemporaneous median and ulnar SSEP AE of the same limb (P ≤ 0.001).Conclusion: Sex, patient positioning, length of procedure, and BMI are determinants for upper extremity neural compromise during thoracolumbar and lumbosacral spine surgeries. [ABSTRACT FROM AUTHOR]