Abstract
Objective . To assess the information value of comparing the results of formalizing intraoperative changes in transcranial motor evoked potentials during surgical correction of spinal deformities of various etiologies. Material and Methods . Study design: analysis of monocentric retrospective unselected cohort over 5 years, evidence class 2b. Surgical correction of spinal deformity under neurophysiological control was performed in 364 patients (mean age 12.80 ± 0.40 years). The scores of changes in motor evoked potentials were used to compare the pyramidal system response to surgical aggression in patients with congenital spinal deformities, idiopathic scoliosis, and systemic skeletal diseases. Results. Basic motor responses in patients with systemic diseases of the axial skeleton are to a greater extent depressed and unstable than in those with congenital deformity and idiopathic scoliosis. On surgery completion, these differences are exacerbated. Five identified types of response of the spinal cord conduction pathways to surgical correction of spinal deformity allow comparing intraoperative neuromonitoring results in different groups of patients. The most dangerous types of response are observed more often in patients with congenital and systemic pathologies than in those with idiopathic scoliosis. Conclusion . The proposed method for the rank assessment of intraoperative changes in motor evoked potentials during surgical correction of spinal deformity allows comparative studies of patients’ reactions to surgical intervention in different etiological and age groups. The greatest risk of iatrogenic motor disorders in the postoperative period is observed in patients with systemic skeletal pathology.
Highlights
Basic motor responses in patients with systemic diseases of the axial skeleton are to a greater extent depressed and unstable than in those with congenital deformity and idiopathic scoliosis
Зафиксированным в процессе интраоперационного нейромониторинга изменениям характеристик и конфигурации моторных вызванных потенциалов (МВП) присваивали ранг в соответствии с разработанной шкалой [8] от нулевого (Ri = 0 – сохранение на момент текущего i-тестирования формы и амплитудно-временных параметров МВП близкими к исходным) до седьмого (Ri = 7 – полное исчезновение МВП без признаков его восстановления к моменту завершения хирургического вмешательства)
На момент завершения операции во всех группах ощутимо увеличилось количество наблюдений с полным отсутствием МВП за счет случаев с V типом реакции пирамидной системы
Summary
To assess the information value of comparing the results of formalizing intraoperative changes in transcranial motor evoked potentials during surgical correction of spinal deformities of various etiologies. The scores of changes in motor evoked potentials were used to compare the pyramidal system response to surgical aggression in patients with congenital spinal deformities, idiopathic scoliosis, and systemic skeletal diseases. Basic motor responses in patients with systemic diseases of the axial skeleton are to a greater extent depressed and unstable than in those with congenital deformity and idiopathic scoliosis On surgery completion, these differences are exacerbated. The proposed method for the rank assessment of intraoperative changes in motor evoked potentials during surgical correction of spinal deformity allows comparative studies of patients’ reactions to surgical intervention in different etiological and age groups. Маскируется роль возраста и связанной с ним степени созревания нервной системы, этиологии, вида и количественных характеристик деформации позвоночника в определении степени риска возникновения в послеоперационном периоде ятрогенных моторных расстройств. Цель исследования – оценка информативности сравнения результатов формализации интраоперационных изменений транскраниально вызванных моторных потенциалов при хирургической коррекции деформации позвоночника разной этиологии
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