Prognostic significance of no recovery of motor evoked potentials and H-reflex in open thoracoabdominal aortic repair

Authors:

Эдуард Рафаэлович Чарчян,

Анатолий Олегович Горягин,

Денис Геннадьевич Брешенков,

Вадим Олегович Русскин,

Глеб Антонович Мальгин,

Дмитрий Александрович Фролов,

Анна Борисовна Степаненко,

Юрий Владимирович Белов

Журнал: Хирургия. Журнал им. Н.И. Пирогова. 2026;(10):5-11.

DOI: 10.17116/hirurgia20261015

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Abstract

OBJECTIVE

To evaluate prognostic value of reversible and persistent intraoperative changes in somatosensory evoked potentials, motor evoked potentials and H-reflex for postoperative motor neurological deficit after open thoracoabdominal aortic replacement.

MATERIAL AND METHODS

A single-center prospective observational study included 59 patients who underwent open thoracoabdominal aortic replacement under intraoperative neurophysiological monitoring. Somatosensory evoked potentials were recorded in 58 patients (98.3%), motor evoked potentials in 54 (91.5%), and H-reflex in 24 (40.7%) patients. The primary endpoint was new postoperative motor neurological deficit. Diagnostic performance of any signal decrease and no recovery by the end of surgery was assessed. An exploratory analysis of surgical factors associated with persistent absent recovery of motor evoked potentials and/or H-reflex was also performed.

RESULTS

Postoperative spinal cord ischemia was detected in 4/59 patients (6.8%): 3 cases of monoparesis (5.1%) and 1 case of paraplegia (1.7%). Any evoked potential decrease had high sensitivity but low specificity. No recovery of somatosensory evoked potentials among patients with their decrease had 25.0% sensitivity and 95.1% specificity. No recovery of motor evoked potentials had 75.0% sensitivity and 71.4% specificity, no recovery of H-reflex — 100.0% sensitivity and 53.3% specificity. The combined criterion of no recovery of motor evoked potentials and/or H-reflex demonstrated 100.0% sensitivity, 70.6% specificity and 100.0% negative predictive value. In exploratory analysis of surgical factors, significant difference was found in the number of intraoperatively sutured thoracic intercostal arteries: 4 [3; 5] in the absent recovery group versus 6 [4; 8] in the recovery group (p=0.048).

CONCLUSION

Persistent abnormalities remaining by the end of surgery have the greatest prognostic value rather than any intraoperative signal decrease. No recovery of motor evoked potentials and/or the H-reflex may be considered a clinically relevant risk factor for postoperative motor deficit.

Keywords

thoracoabdominal aortic aneurysm
thoracoabdominal aortic replacement
spinal cord ischemia
motor evoked potentials
H-reflex
intraoperative neurophysiological monitoring
neurological complications

Участие авторов

Concept and design of the study — Charchyan E.R.,Goryagin A.O., Belov Yu.V.

Data collection and processing — Goryagin A.O.,Breshenkov D.G., Russkin V.O., Malgin G.A., Frolov D.A.

Text writing — Goryagin A.O., Breshenkov D.G.,Russkin V.O.

Editing — Charchyan E.R., Stepanenko A.B., Belov Yu.V

Конфликт интересов

The authors declare no conflict of interest.

Дата поступления: 14.05.2026

Дата принятия в печать: 10.06.2026

Дата публикации: 05.10.2026

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