Aim: To correlate electroneuromyigraphic (ENMG) manifestations of post-operative motor deficit developed in patients after spinal deformity correction with qualitative evaluation of the severity of intra-operative pyramidal disorders according to protocol of intra-operative neuromonitoring (IONM).
Material And Methods: ENMG data of 87 patients aged 6-43 years with spinal deformities of different etiology were analyzed before and after surgical correction and were correlated with intra-operative neuromonitoring course.
Results: We have identified five types of the intraoperative reaction of pyramidal system to surgical aggression. Severity of postoperative motor deficit was the most pronounced after the fifth type of reaction according to electromyography (complete prolonged oppression of motor evoked potentials).
Conclusion: We suggested the scale of intra-operative pyramidal disorders severity that is satisfactorily correlated with functional surgical outcomes which are reflected in the dynamics of particular and integral characteristics of voluntary and evoked bioelectrical activity of the lower limb muscles. This fact makes possible to use safely the above-mentioned protocol for IONM, to predict postoperative motor disorders and to formulate reasonably the recommendations for postoperative management.
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http://dx.doi.org/10.17116/hirurgia2017419-23 | DOI Listing |
Spine Deform
October 2024
Department of Orthopedic Surgery, Center for Spinal Disorders, Nicklaus Children's Hospital, 3100 SW 62nd Avenue, Miami, FL, 33155, USA.
ANZ J Surg
December 2024
Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Australia.
Introduction: Intra-operative neuromonitoring including somatosensory evoked potentials, motor evoked potentials, and electromyography, have replaced the Stagnara wake-up test to allow early detection of neurological change during paediatric spinal deformity surgery. It is important for surgeons to recognize alerts triggered by loss of these potentials and act accordingly to prevent iatrogenic neurological damage intra-operatively. This study was conducted to determine the sensitivity and specificity of neuromonitoring alerts in paediatric spinal deformity correction surgery.
View Article and Find Full Text PDFJ Orthop Case Rep
August 2024
Scottish National Spine Deformity Centre, Royal Hospital for Children and Young People, Edinburgh, UK.
Introduction: Multimodal intraoperative neuromonitoring (IOM) is essential in scoliosis surgery. This is affected by misplaced instrumentation, cord trauma, hemodynamic instability, and anesthesia. We present an irreversible loss of IOM without identifiable intra-operative cause to highlight its occurrence and discuss post-operative investigations and management.
View Article and Find Full Text PDFCureus
June 2024
Machine Learning, Inspired Spine Health, Minneapolis, USA.
Introduction: This study presents findings from an investigation into the correlation of neuromonitoring techniques in minimally invasive lumbar fusions and their open counterparts regarding acceptable thresholds for screw stimulation. The threshold for acceptable stimulation value for open surgery has been established. The study compared acceptable thresholds for open pedicle screws where there is more connection between the screw and the soft tissue.
View Article and Find Full Text PDFCureus
April 2024
Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, Toronto, CAN.
The correction of anemia is important in reversing significant intraoperative bilateral motor-evoked potential (MEP) loss following rod placement for correction of large scoliosis curves. This article presents a retrospective review of intraoperative neuromonitoring (IONM) data, anesthesia records, and medical charts of two patients with significant bilateral MEP changes associated with posterior spinal surgery for deformity correction. A 70 kg 12-year-old and a 44 kg 16-year-old female with main thoracic curves underwent a posterior scoliosis correction with multilevel posterior column osteotomies.
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