Abstract
Background. Treatment of severe spinal deformity remains a challenging surgical problem, with an iatrogenic injury to the spinal cord being a critical complication. There is a high risk of neurological deficit following surgical correction of a severe spinal deformity.
 Aim. To determine the relationship between the extent of disturbed thermal and pain sensations at Th1-S2 dermatomas and the intensity of the spinal cord pathways’ responses to surgical correction of the severe spinal deformity.
 Material and methods. We reviewed 58 patients with severe spinal deformities of different etiologies (mean age, 15.7±0.8 years). All patients underwent surgical deformity correction followed by thoracic/thoracolumbar spine fixation by using a variety of internal transpedicular fixations. Intraoperative neurophysiological monitoring (IONM) with transcranial motor-evoked potentials (MEPs) was used during operative interventions. Preoperative and postoperative thermal and pain sensations were assessed in Th1-S2 dermatomas to the right and left by using an electrical aesthesiometer.
 Results. The extent of disturbed preoperative and postoperative thermal and pain sensations in Th1-S2 dermatomas before and after correction of spinal deformities correlated with the response type scale (I–V) of the spinal cord pathways to the surgical correction we offered. Correlation between the response type and characteristics of thermal and pain sensations was mostly revealed by the test results for the thermal pain threshold (thermal analgesia). The incidence of postoperative thermal analgesia increased monotonically from patients with response type I (persistent MEP form and amplitude-time parameters close to the baseline) to patients with response type V (higher risk of neurological complications). The overall rate of thermal analgesia increased after surgical correction of the spinal deformity relative to the baseline and was higher (≤8%) in patients with response type V.
 Conclusions. Surgeons and neurophysiologists who perform IONM should give careful attention to patients with severe spinal deformity who exhibit marked postoperative thermal analgesia.
Highlights
Treatment of severe spinal deformity remains a challenging surgical problem, with an iatrogenic injury to the spinal cord being a critical complication
There is a high risk of neurological deficit following surgical correction of a severe spinal deformity
Preoperative and postoperative thermal and pain sensations were assessed in Th1-S2 dermatomas to the right and left by using an electrical aesthesiometer
Summary
ФГБУ «Российский научный центр «Восстановительная травматология и ортопедия» имени академика Г.А. Цель исследования — определение характера взаимосвязи между степенью нарушения температурно-болевой чувствительности в области дерматомов Th1-S2 и интенсивностью реакции проводящих путей спинного мозга на хирургическую коррекцию тяжелых деформаций позвоночника. Степень нарушения температурно-болевой чувствительности в области дерматомов Th1-S2 до и после оперативной коррекции деформации позвоночника коррелирует с предложенной нами шкалой типов реакций (I–V) проводящих путей спинного мозга на хирургическую агрессию. Частота встречаемости термоаналгезии в предоперационном периоде монотонно возрастает от группы пациентов с первым типом реакции (сохранение на момент тестирования формы и амплитудно-временных параметров МВП, близкими к исходным) к группе больных с пятым типом (высокий риск неврологических осложнений). После оперативной коррекции деформации позвоночника общая частота термоаналгезии повышается по сравнению с исходным уровнем, но в большей степени (до 8 %) термоаналгезия регистрируется в группе больных с пятым типом реакции. &Žƌ ĐŝƚĂƚŝŽŶ WĞĚŝĂƚƌŝĐ dƌĂƵŵĂƚŽůŽŐLJ KƌƚŚŽƉĂĞĚŝĐƐ ĂŶĚ ZĞĐŽŶƐƚƌƵĐƚŝǀĞ ^ƵƌŐĞƌLJ ϮϬϭϳρ;κͿρͲϭρ
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Pediatric Traumatology, Orthopaedics and Reconstructive Surgery
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
