Quantitative characterization of risk of iatrogenic damage to pyramidal tracts based on data of intraoperative neuromonitoring during surgical correction of spinal deformities

Saifutdinov M.S.

Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics of the Ministry of Health of Russia, 640014, Kurgan, Russia

Ryabykh S.O.

Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics of the Ministry of Health of Russia, 640014, Kurgan, Russia

Savin D.M.

Federal State Budgetary Institution Russian Ilizarov Scientific Center 'Restorative Traumatology and Orthopaedics', Kurgan, Russia

Tretiakova A.N.

Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics of the Ministry of Health of Russia, 640014, Kurgan, Russia

Quantitative characterization of risk of iatrogenic damage to pyramidal tracts based on data of intraoperative neuromonitoring during surgical correction of spinal deformities

Authors:

Saifutdinov M.S., Ryabykh S.O., Savin D.M., Tretiakova A.N.

More about the authors

Journal: Burdenko's Journal of Neurosurgery. 2019;83(4): 56‑63

DOI: 10.17116/neiro20198304156

Read: 1181 times

To cite this article:

Saifutdinov MS, Ryabykh SO, Savin DM, Tretiakova AN. Quantitative characterization of risk of iatrogenic damage to pyramidal tracts based on data of intraoperative neuromonitoring during surgical correction of spinal deformities. Burdenko's Journal of Neurosurgery. 2019;83(4):56‑63. (In Russ., In Engl.)
https://doi.org/10.17116/neiro20198304156

Подписка 2025-2 (Burdenko's Journal of Neurosurgery)

Использование инфографики авторами научных работ

Close metadata

Recommended articles:

Effectiveness of ESP-block and epidural analgesia in spinal surgery: a prospective randomized study. Russian Journal of Anesthesiology and Reanimatology. 2024;(5):72-81

Contemporary aspects of brain protection in aortic arch surgery. Russian Journal of Cardiology and Cardiovascular Surgery. 2025;(2):164-173

Objective — development of a quantitative indicator for the risk level of intraoperative iatrogenic motor disorders in the process of surgical correction of spinal deformity based on current neurophysiological monitoring data. Material and methods. 288 patients 12.6±0.35 y.o. underwent surgical correction of spinal deformities under the control of intraoperative neuromonitoring. The nature of changes in motor evoked potentials was assessed according to the earlier proposed ranking scale. The incidence of different variants of changes in the rank values of the state of the pyramidal system during the operation and the resulting postoperative motor disturbances was calculated. Results. By comparing probabilities of various changes in the conduction properties of pyramidal tracts during surgery with the incidence of the observed motor deficiencies we quantitatively assessed the possible correlation between these phenomena. We propose a method for calculating the risk index for postoperative motor disorders depending on the maximum rank of the pyramidal system’s response to surgical aggression. Conclusion. The developed system of ranking evaluation of changes in motor evoked potentials during surgical correction of spinal deformity makes it possible to quantify the risk of postoperative motor disorders and, accordingly, to monitor the level of anxiety for a neurosurgeon during individual stages of surgical intervention.

Keywords:

spinal deformity

spinal surgery

intraoperative neuro-monitoring

somatic motor system

neurological complications

Authors:

Saifutdinov M.S.

Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics of the Ministry of Health of Russia, 640014, Kurgan, Russia

Ryabykh S.O.

Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics of the Ministry of Health of Russia, 640014, Kurgan, Russia

Savin D.M.

Federal State Budgetary Institution Russian Ilizarov Scientific Center 'Restorative Traumatology and Orthopaedics', Kurgan, Russia

Tretiakova A.N.

Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics of the Ministry of Health of Russia, 640014, Kurgan, Russia

List of references:

Lee JC, Choi SW. Adjacent Segment Pathology after Lumbar Spinal Fusion. Asian Spine Journal. 2015;9(5):807-817. https://doi.org/10.4184/asj.2015.9.5.807
Samartzis D, Leung Y, Shigematsu H, Natarajan D, Stokes O, Mak K, Yao G, Luk K, Cheung K. Selection of fusion levels using the fulcrum bending radiograph for the management of adolescent idiopathic scoliosis patients with alternate level pedicle screw strategy: clinical decision-making and outcomes. Park P, ed. PLoS ONE. 2015;10(8):e0120302. https://doi.org/10.1371/journal.pone.0120302
Zhou Z, Zhang H, Guo C, Yu H, Wang L, Guo Q. More preoperative flexibility implies adequate neural pliability for curve correction without prophylactic untethering in scoliosis patients with asymptomatic tethered spinal cord, a retrospective study. BMC Musculoskeletal Disorders. 2017;18:261. https://doi.org/10.1186/s12891-017-1615-0
Reames DL, Smith JS, Fu KM, Polly DW Jr, Ames CP, Berven SH, Perra JH, Glassman SD, McCarthy RE, Knapp RD. Jr, Heary R, Shaffrey CI. Complications in the surgical treatment of 19,360 cases of pediatric scoliosis: a review of the Scoliosis Research Society Morbidity and Mortality database. Spine. 2011;36(18):1484-1491. https://doi.org/10.1097/BRS.0b013e3181f3a326
Khit MA, Kolesov SV, Kolbovky DA, Morozova NS. The role of intraoperative neurophysiological monitoring in prevention of postoperative neurological complications in scoliotic spinal deformation surgery. Nervno-myshechnye bolezni. 2014;(2):36-41. (In Russ.) https://doi.org/10.17650/2222-8721-2014-0-2-36-41
Aleem AW, Thuet ED, Padberg AM, Wallendorf M, Luhmann SJ, Spinal Cord Monitoring Data in Pediatric Spinal Deformity Patients With Spinal Cord Pathology. Spine Deformity. 2015;3:88-94. https://doi.org/10.1016/j.jspd.2014.06.011
Kuzmina VA, Syundyukov AR, Nikolaev NS, Mikhailova IV, Nikolaeva AV. Effectiveness of intraoperative neurophysiological monitoring during spinal surgery. Ortopediya, travmatologiya i vosstanovitel’naya khirurgiya detskogo vozrasta. 2016; 4(4)33-40. (In Russ.) https://doi.org/10.17816/PTORS4433-40
Acharya S, Palukuri N, Gupta P. and Kohli M. Transcranial Motor Evoked Potentials during Spinal Deformity Corrections—Safety, Efficacy, Limitations, and the Role of a Checklist. Front. Surg. 2017;13(4):8. https://doi.org/10.3389/fsurg.2017.00008
Kobayashi K, Imagama S, Ito Z, Ando K, Hida T, Ito K, Tsushima M, Ishikawa Y, Matsumoto A, Nishida Y, Ishiguro N. Transcranial motor evoked potential wave form changes in corrective fusion for adolescent idiopathic scoliosis. J Neurosurg Pediatr. 2017;19(1):108-115. https://doi.org/10.3171/2016.6.PEDS16141
Kothbauer KF. The Interpretation of Muscle Motor Evoked Potentials for Spinal Cord Monitoring. J ClinNeurophysiol. 2017 Jan;34(1):32-37. https://doi.org/10.1097/WNP.0000000000000314
Novikov VV, Novikova MV, Tsvetovsky SB, Lebedeva MN, Mikhaylovsky MV, Vasyura AS, Dolotin DN, Udalova IG. Prevention of NeurologicalComplications in Correction Surgery for Severe Spinal Deformities. Khirurgia Pozvonochnika. 2011;(3):66-76. (In Russ.)
Sayfutdinov MS, Skripnikov AA, Ryabykh SO, Ochirova PV. Scoreevaluation of intraoperativeneurophysiological monitoring results of spinal deformity surgical correction in genetically caused systemic skeletal pathology. Genij Ortopedii. 2017;23(2):201-205. (In Russ.) https://doi.org/10.18019/1028-4427-2017-23-2-201-205
Riabykh SO. The choice of surgical approach for congenital spinal deformity caused by multiple vertebral malformations. Khirurgia Pozvonochnika. 2014;2:21-28. (In Russ.) https://doi.org/10.14531/ss2014.2.21-28
Riabykh SO., Savin DM. Possibilities of Type III kyphoses surgical treatment using 'Pedicle subtraction osteotomy'; technique. Geniy Ortopedii. 2013;(1):120-123. (In Russ.)
Schwab F, Blondel B, Chay E, Demakakos J et al. The Comprehensive Anatomical Spinal Osteotomy Classification. Neurosurgery. 2014;74(1):112-120. https://doi.org/10.1227/NEU.0000000000000182o
Shein AP, Krivoruchko GA, Ryabykh SO [Reactivity and resistance of the spinal structures when performing instrumental correction of spinal deformities]. Rossiiskii fiziologicheskii zhurnal im. I.M. Sechenova. 2016;102(12):1495-1506. (In Russ.)
Jameson LC. Transcranial Motor Evoked Potentials in Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals. Eds. Koht A., Sloan TB, Toleikis JR. New York—Dordrecht—Heidelberg—London: Springer, 2012;27-45. https://doi.org/10.1007/978-1-4614-0308-1
Gaydyshev IP. Analiz i obrabotka dannykh: spetsial’nyi spravochnik. Data analysis and processing: a special reference book. SPb.: Piter, 2001;752. (In Russ.)
Gibson PRJ. Anaesthesia for Correction of Scoliosis in Children. Anaesth. Intensive Care. 2004;32(4):548-559.
Lieberman JA, Lyon R, Feiner J, Diab M, Gregory GA. The effect of age on motor evoked potentials in children under propofol/isoflurane anesthesia. Anesth Analg. 2006;103(2):316-321. https://doi.org/10.1213/01.ane.0000226142.15746.b2
Koruk S, Mizrak A, Kaya UB, Ilhan O, Baspinar O, Oner U. Propofol/dexmedetomidne and propofol/ketamine combinations for anesthesia in pediatric patients undergoing transcatheter atrial septal defect closure: a prospective randomized study; Clin Ther. 2010;32(4):701-709.
Furmaga H, Park HJ, Cooperrider J, Baker KB, Johnson M, Gale JT, Machado AG. Effects of ketamine and propofol on motor evoked potentials elicited by intracranial microstimulation during deep brain stimulation. Frontiers in Systems Neuroscience. 2014;8:Article 89. https://doi.org/10.3389/fnsys.2014.00089
Korolyuk VS, Portenko NI, Skorokhod AV, Turbin AF. Handbook on probability theory and mathematical statistics. M.: Nauka, 1985;640. (In Russ.)

Close metadata