A neuroelectrophysiological monitoring device and method for spinal surgery

Abstract

The present invention relates to a neuroelectrophysiological monitoring device and method for use during spinal surgery. A neuroelectrophysiological monitoring device for use during spinal surgery, the monitoring device comprising an electroencephalogram (EEG) monitoring module, an intraoperative neural stimulation monitoring module, a synchronization signal module, and an abnormal electrophysiological event warning module. The EEG monitoring module is used to receive the patient's intraoperative EEG data, the intraoperative neural stimulation monitoring module is used to monitor evoked potential data and to perform SEP and / or MEP stimulation on the patient during surgery, the synchronization signal module is used to synchronize EEG data and evoked potential data, and the abnormal electrophysiological event warning module warns of abnormal electrophysiological events based on EEG data and evoked potential data. The technical solution adopted by the present invention can realize intraoperative neural monitoring and can detect new neural dysfunctions early so as to correct the causes in time. The EEG monitoring method of the present invention can also accurately record adverse reactions occurring during surgery, thereby performing retrospective analysis.

Description

Technical Field

[0001] The invention relates to a neuroelectrophysiological monitoring device and method used in spinal surgery. Background Art

[0002] Spinal surgery involves a wide range of operations, and the risk of injury to the spinal nerve roots and their main blood vessels is high. In the past, local anesthesia or general anesthesia intraoperative awakening methods were often used to avoid intraoperative damage to the spinal cord and nerves, but this increases surgical risks and patient pain, and is not suitable for pediatric patients. Intraoperative neurophysiological monitoring provides a role in protecting the integrity of intraoperative neurological function for spinal surgery.

[0003] In the past, EEG in neuroelectrophysiological monitoring during spinal surgery was usually not taken seriously by the monitor or even included in the monitoring scope, which inevitably resulted in a decrease in the accuracy of electrophysiological monitoring and an increase in the incidence of related complications such as anesthesia.

[0004] When SEP and / or MEP change, orthopedic surgeons usually prefer to focus on motor function first, so electrophysiological monitoring physicians usually first choose to increase the SEP and / or MEP stimulation to observe motor induction. However, if the change in evoked potential is due to ischemia or hemorrhage in the cerebral cortex, blindly increasing the SEP and / or MEP stimulation may activate the subcortical structure so that SEP and / or MEP will be re-elicited. At this time, we will not be able to detect and feedback possible cortical lesions in time, resulting in extremely serious consequences such as false negatives. Summary of the invention

[0005] The purpose of the present invention is to solve the deficiencies of the prior art and to provide a neuroelectrophysiological monitoring device and method for use during spinal surgery. The monitoring device includes an EEG monitoring module, an intraoperative neural stimulation monitoring module, a synchronization signal module, and an abnormal electrophysiological event warning module. The EEG monitoring module is used to receive the patient's intraoperative EEG data, the intraoperative neural stimulation monitoring module is used to monitor evoked potential data and to perform SEP and / or MEP stimulation on the patient during surgery, the synchronization signal module is used to synchronize EEG data and evoked potential data, and the abnormal electrophysiological event warning module issues abnormal electrophysiological event warnings based on the EEG data and evoked potential data.

[0006] The abnormal electrophysiological event warning module comprises the following steps:

[0007] According to the evoked potential data, if the amplitude decreases by more than 50% or the latency increases by more than 10%, the fast wave power percentage is calculated based on the fast wave and slow wave data in the brain wave. If the fast wave power percentage exceeds the preset threshold, an electrophysiological abnormality warning is issued;

[0008] If the fast wave power percentage does not exceed the preset threshold, the SEP and / or MEP stimulation amount is increased, and the evoked potential data after the increase in the SEP and / or MEP stimulation amount is analyzed. If the amplitude decrease continues to be greater than 50% or the latency extension continues to be greater than 10%, an electrophysiological abnormality alarm is issued; if the amplitude decrease continues to be less than 50% and the latency extension continues to be less than 10%, the SEP and / or MEP stimulation amount is reduced, and the amplitude and latency of the evoked potential data continue to be monitored.

[0009] The abnormal electrophysiological event warning module also includes the following steps

[0010] The EEG monitoring module collects EEG signals and monitors the burst-suppression state in real time.

[0011] If an abnormality is found, the abnormal electrophysiological event warning module will issue an electrophysiological abnormality warning.

[0012] If SEP and / or MEP stimulation is performed when an electrophysiological abnormality warning is issued, the output of the stimulation signal and the confirmation of the output adjustment will pop up, and the brain wave signal will be automatically and synchronously displayed when the SEP / MEP signal is output. If the brain wave does not change, the stimulation and SEP / MEP signal waveform display will be performed normally.

[0013] The abnormal electrophysiological event warning module synchronously displays the ratio of brain wave energy value and SEP / MEP energy value.

[0014] A neuroelectrophysiological monitoring method for spinal surgery, the monitoring method comprising the following steps:

[0015] Receive the patient's intraoperative EEG data and evoked potential data;

[0016] Synchronize EEG data and evoked potential data;

[0017] Alerts for abnormal electrophysiological events based on EEG data and evoked potential data.

[0018] The monitoring method comprises the following steps:

[0019] According to the evoked potential data, if the amplitude decreases by more than 50% or the latency increases by more than 10%, the fast wave power percentage is calculated based on the fast wave and slow wave data in the brain wave. If the fast wave power percentage exceeds the preset threshold, an electrophysiological abnormality warning is issued;

[0020] If the fast wave power percentage does not exceed the preset threshold, the SEP and / or MEP stimulation amount is increased, and the evoked potential data after the increase in the SEP and / or MEP stimulation amount is analyzed. If the amplitude decrease continues to be greater than 50% or the latency extension continues to be greater than 10%, an electrophysiological abnormality alarm is issued; if the amplitude decrease continues to be less than 50% and the latency extension continues to be less than 10%, the SEP and / or MEP stimulation amount is reduced, and the amplitude and latency of the evoked potential data continue to be monitored.

[0021] The monitoring method further comprises the following steps: the EEG monitoring module collects EEG signals and monitors the burst-suppression state in real time,

[0022] If an abnormality is found, the abnormal electrophysiological event warning module will issue an electrophysiological abnormality warning.

[0023] If SEP and / or MEP stimulation is performed when an electrophysiological abnormality warning is issued, the output of the stimulation signal and the confirmation of the output adjustment will pop up, and the brain wave signal will be automatically and synchronously displayed when the SEP / MEP signal is output. If the brain wave does not change, the stimulation and SEP / MEP signal waveform display will be performed normally.

[0024] Our cooperative hospital once received one case of cerebral ischemia and subarachnoid hemorrhage in a patient whose partial recovery of evoked potentials was not given enough attention. It was not until several hours after the operation that the patient was examined that cerebral ischemia and subarachnoid hemorrhage were discovered. It can be seen that although the probability of this happening is low, it should still attract enough attention from the monitoring physician. Although EEG intuitively shows the site of cerebrovascular accident, it is often not discovered until the postoperative examination or the analysis of the event combined with intraoperative EEG recording. We found that continuous EEG monitoring showed that the rhythmic activity of the patient's brain waves would change rapidly in mild to moderate cerebral ischemia, typically manifested as a decrease in fast waves; as the ischemic time and degree of ischemia increase, diffuse slow wave activity and even isoelectric potential will appear in the brain waves, which indicates that EEG monitoring has potential application value in the diagnosis of diseases such as acute stroke.

[0025] The technical solution adopted by the present invention can realize intraoperative neurological monitoring and early detection of new neurological dysfunction so as to correct the cause in time. The EEG monitoring method of the present invention can also accurately record adverse reactions occurring during surgery, so as to conduct retrospective analysis.

[0026] The above and other features, aspects and advantages of the present application will be more readily understood with reference to the following detailed description. DETAILED DESCRIPTION

[0027] In order to make the purpose, technical solution and advantages of the embodiment of the present invention clearer, the technical solution of the embodiment of the present invention will be clearly and completely described in combination with the embodiment of the present invention. Obviously, the described embodiment is a part of the embodiment of the present invention, not all of the embodiments. Based on the described embodiment of the present invention, all other embodiments obtained by ordinary technicians in this field without creative work belong to the scope of protection of the present invention.

[0028] Unless otherwise defined, the technical or scientific terms used herein shall have the common meanings understood by persons with ordinary skills in the field to which the present invention belongs. The words "first", "second" and similar words used in the patent application specification and claims of the present invention do not indicate any order, quantity or importance, but are only used to distinguish different components. Similarly, words such as "one" or "a" do not indicate a quantity limitation, but indicate the existence of at least one.

[0029] Intraoperative EEG burst-inhibition states cause a decrease in the amplitude of SEP / MEP and / or a prolongation of the latency period, and the disappearance of EEG activity can also be seen as the disappearance of the SEP / MEP waveform. At this time, it is impossible to judge the impact of the surgical operation on the spinal cord based on the evoked potential; abnormal conditions are promptly reported to the anesthesiologist and surgeon after they are discovered, and abnormal conditions caused by anesthetic factors are promptly corrected, and related evoked potential conditions also improve accordingly. When anesthesia is too deep, the EEG changes from normal to a burst-inhibition state, and the SEP / MEP signal recorded by the recording electrode at the corresponding time shows a decrease / disappearance. When the anesthesia depth is corrected and the EEG returns to normal, the SEP / MEP waveform recovers; other evoked potential abnormal events that exclude anesthetic factors are handled by the surgeon according to the situation at the time.

[0030] A neuroelectrophysiological monitoring device and method for use during spinal surgery, the monitoring device comprising an EEG monitoring module, an intraoperative neural stimulation monitoring module, a synchronization signal module, and an abnormal electrophysiological event warning module, the EEG monitoring module being used to receive the patient's intraoperative EEG data, the intraoperative neural stimulation monitoring module being used to monitor evoked potential data and to perform SEP and / or MEP stimulation on the patient during surgery, the synchronization signal module being used to synchronize EEG data and evoked potential data, and the abnormal electrophysiological event warning module providing abnormal electrophysiological event warnings based on the EEG data and evoked potential data.

[0031] Specifically, the abnormal electrophysiological event warning module includes the following steps:

[0032] According to the evoked potential data, if the amplitude decreases by more than 50% or the latency increases by more than 10%, the fast wave power percentage is calculated based on the fast wave and slow wave data in the brain wave. If the fast wave power percentage exceeds the preset threshold, an electrophysiological abnormality warning is issued;

[0033] If the fast wave power percentage does not exceed the preset threshold, the SEP and / or MEP stimulation amount is increased, and the evoked potential data after the increase in the SEP and / or MEP stimulation amount is analyzed. If the amplitude decrease continues to be greater than 50% or the latency extension continues to be greater than 10%, an electrophysiological abnormality alarm is issued; if the amplitude decrease continues to be less than 50% and the latency extension continues to be less than 10%, the SEP and / or MEP stimulation amount is reduced, and the amplitude and latency of the evoked potential data continue to be monitored.

[0034] Fast waves: When awake, calm, and relaxed with eyes closed, normal people's brain waves are often between 8 and 13 Hz (Hertz, a unit), which is the frequency of alpha waves. Alpha waves are the most basic elements of brain waves, and fast EEG waves usually refer to brain waves faster than alpha waves, with a frequency of more than 14 Hz. They are the main components of normal awake EEGs, are widely distributed, and are not affected by eyes open or closed. They are generally considered to be the brain wave manifestation when the neocortex is in a state of intense activity.

[0035] Slow waves: Slow waves in the EEG usually refer to brain waves that are slower than alpha waves, that is, brain waves below 8Hz. Physiological slow waves can be seen, such as the brain waves of children, the brain waves of adults in a state of sleep or fatigue, etc. Diffuse slow waves and focal slow waves can also be seen in pathology, which means that there are serious lesions in the cerebral cortex or near-cortical white matter of the tissue. Diffuse slow waves can be seen in diffuse and hypoxic encephalopathy, as well as degenerative diseases of the central nervous system, etc., while focal slow waves are more common in subdural hematoma, focal epilepsy, brain abscess, etc.

[0036] The abnormal electrophysiological event warning module also includes the following steps

[0037] The EEG monitoring module collects EEG signals and monitors the burst-suppression state in real time.

[0038] If an abnormality is found, the abnormal electrophysiological event warning module will issue an electrophysiological abnormality warning.

[0039] If SEP and / or MEP stimulation is performed when an electrophysiological abnormality warning is issued, the output of the stimulation signal and the confirmation of the output adjustment will pop up, and the brain wave signal will be automatically and synchronously displayed when the SEP / MEP signal is output. If the brain wave does not change, the stimulation and SEP / MEP signal waveform display will be performed normally.

[0040] The abnormal electrophysiological event warning module synchronously displays the ratio of brain wave energy value and SEP / MEP energy value.

[0041] A neuroelectrophysiological monitoring method for spinal surgery, the monitoring method comprising the following steps: receiving the patient's intraoperative brain wave data and evoked potential data; synchronizing the brain wave data and evoked potential data; and providing an abnormal electrophysiological event warning based on the brain wave data and evoked potential data.

[0042] The monitoring method includes the following steps:

[0043] According to the evoked potential data, if the amplitude decreases by more than 50% or the latency period prolongs by more than 10%, the fast wave power percentage is calculated based on the fast wave and slow wave data in the brain waves. If the fast wave power percentage exceeds the preset threshold, an electrophysiological abnormality warning is issued; if the fast wave power percentage does not exceed the preset threshold, the SEP and / or MEP stimulation amount is increased, and the evoked potential data after the increase in the SEP and / or MEP stimulation amount is analyzed. If the amplitude decrease continues to be greater than 50% or the latency period prolongs by more than 10%, an electrophysiological abnormality warning is issued; if the amplitude decrease continues to be less than 50% and the latency period prolongs by less than 10%, the SEP and / or MEP stimulation amount is reduced, and the amplitude and latency of the evoked potential data continue to be monitored.

[0044] Through the above-mentioned monitoring method, abnormal conditions such as cerebral ischemia and subarachnoid hemorrhage in patients can be effectively detected.

[0045] The monitoring method further comprises the following steps:

[0046] The EEG monitoring module collects EEG signals and monitors the burst-inhibition status in real time. If an abnormality is found, the abnormal electrophysiological event warning module will promptly issue an electrophysiological abnormality warning. If SEP and / or MEP stimulation is performed when the electrophysiological abnormality warning is issued, the output of the stimulation signal and the confirmation of the output adjustment will pop up, and the EEG signal will be automatically and synchronously displayed when the SEP / MEP signal is output. If the brain wave has not changed, the stimulation and SEP / MEP signal waveform display will be performed normally.

[0047] Through the above method, SEP and / or MEP stimulation can be effectively performed to reduce the situation of erroneous stimulation. The solution of the present invention monitors brain waves and evoked potentials at the same time, and the two cooperate with each other to improve the efficiency of intraoperative monitoring and provide doctors with sufficient prompts and warnings.

[0048] The above shows and describes the basic principles and main features of the present invention and the advantages of the present invention. It is obvious to those skilled in the art that the present invention is not limited to the details of the above exemplary embodiments, and the present invention can be implemented in other specific forms without departing from the spirit or basic features of the present invention. Therefore, no matter from which point of view, the embodiments should be regarded as exemplary and non-restrictive. The scope of the present invention is defined by the appended claims rather than the above description, and it is intended that all changes that fall within the meaning and scope of the equivalent elements of the claims are included in the present invention.

[0049] In addition, it should be understood that although this specification is described in terms of implementation methods, not every implementation method contains only one independent technical solution. This description method of the specification is only for the sake of clarity. Those skilled in the art should regard the specification as a whole. The technical solutions in each embodiment can also be appropriately combined to form other implementation methods that can be understood by those skilled in the art.

Claims

1. A neurophysiological monitoring device for spinal surgery, characterized in that: The monitoring device includes an EEG monitoring module, an intraoperative nerve stimulation monitoring module, a synchronization signal module, and an abnormal electrophysiological event warning module. The EEG monitoring module is used to receive the patient's intraoperative EEG data, the intraoperative nerve stimulation monitoring module is used to monitor the evoked potential data and to perform SEP and / or MEP stimulation on the patient during the operation, the synchronization signal module is used to synchronize the EEG data and the evoked potential data, and the abnormal electrophysiological event warning module performs abnormal electrophysiological event warning according to the EEG data and the evoked potential data; The abnormal electrophysiological event warning module comprises the following steps: According to the evoked potential data, if the amplitude decreases by more than 50% or the latency period prolongs by more than 10%, the fast wave power percentage is calculated based on the fast wave and slow wave data in the brain wave. If the fast wave power percentage exceeds the preset threshold, an electrophysiological abnormality warning is issued; If the fast wave power percentage does not exceed the preset threshold, the SEP and / or MEP stimulation amount is increased, and the evoked potential data after the increase in the SEP and / or MEP stimulation amount is analyzed. If the amplitude decreases continue to be greater than 50% or the latency continues to be extended by more than 10%, an electrophysiological abnormality alarm is issued; if the amplitude decreases continue to be less than 50% and the latency continues to be extended by less than 10%, the SEP and / or MEP stimulation amount is reduced, and the amplitude and latency of the evoked potential data continue to be monitored.

2. The neuroelectrophysiological monitoring device for spinal surgery according to claim 1, characterized in that: The abnormal electrophysiological event warning module further comprises the following steps: The EEG monitoring module collects EEG signals and monitors the burst-suppression state in real time. If an abnormality is found, the abnormal electrophysiological event warning module will issue an electrophysiological abnormality warning. If SEP and / or MEP stimulation is performed when an electrophysiological abnormality warning is issued, the output of the stimulation signal and the confirmation of the output adjustment will pop up, and the brain wave signal will be automatically and synchronously displayed when the SEP / MEP signal is output. If the brain wave does not change, the stimulation and SEP / MEP signal waveform display will be performed normally.

3. The neuroelectrophysiological monitoring device for spinal surgery according to claim 2, characterized in that: The abnormal electrophysiological event warning module synchronously displays the ratio of brain wave energy value and SEP / MEP energy value.

4. A neuroelectrophysiological monitoring method for spinal surgery, characterized in that: The monitoring method comprises the following steps: Receive the patient's intraoperative EEG data and evoked potential data; Synchronize EEG data and evoked potential data; Provide warnings for abnormal electrophysiological events based on EEG data and evoked potential data; The abnormal electrophysiological event warning method comprises the following steps: According to the evoked potential data, if the amplitude decreases by more than 50% or the latency period prolongs by more than 10%, the fast wave power percentage is calculated based on the fast wave and slow wave data in the brain wave. If the fast wave power percentage exceeds the preset threshold, an electrophysiological abnormality warning is issued; If the fast wave power percentage does not exceed the preset threshold, the SEP and / or MEP stimulation amount is increased, and the evoked potential data after the increase in the SEP and / or MEP stimulation amount is analyzed. If the amplitude decreases continue to be greater than 50% or the latency continues to be extended by more than 10%, an electrophysiological abnormality alarm is issued; if the amplitude decreases continue to be less than 50% and the latency continues to be extended by less than 10%, the SEP and / or MEP stimulation amount is reduced, and the amplitude and latency of the evoked potential data continue to be monitored.

5. The neuroelectrophysiological monitoring method for spinal surgery according to claim 4, further comprising the following steps: The EEG monitoring module collects EEG signals and monitors the burst-suppression state in real time. If an abnormality is found, the abnormal electrophysiological event warning module will issue an electrophysiological abnormality warning. If SEP and / or MEP stimulation is performed when an electrophysiological abnormality warning is issued, the output of the stimulation signal and the confirmation of the output adjustment will pop up, and the brain wave signal will be automatically and synchronously displayed when the SEP / MEP signal is output. If the brain wave does not change, the stimulation and SEP / MEP signal waveform display will be performed normally.