PRACTICAL ASPECTS OF INTRAOPERATIVE NEUROMONITORING IN PATIENTS WITH DIFFERENT SPINAL PATHOLOGIES

Authors

  • Oleksandr Barkov Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine https://orcid.org/0000-0003-2161-416X
  • Diana Duplii Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine

DOI:

https://doi.org/10.15674/0030-5987202145-12

Keywords:

Intraoperative monitoring, motor evoked potentials, screw stimulation test, spinal pathology

Abstract

Objective. To study the operating parameters and phenomena of intraoperative monitoring and to identify the specificity and sensitivity
of its different modalities associated with postoperative neurological complications in patients with different spinal pathologies.
Methods. The intraoperative neurophysiological monitoring (IOM) protocols of 88 patients who underwent spinal surgeries were analyzed:
kyphoscoliotic spinal deformities — 58 (68 %), traumatic — 12 (13.3 %), degenerative diseases — 10 (11.7 %), neoplasms — 6 (6.7 %). In 33 (38.4 %) cases, a combination of modalities of motor evoked potentials (MEP) and transpedicular screws stimulation (TSS) was used, in 36 (41.9%) — only MEP, 17 (19.8 %) — TSS. In all cases, freerun and triggered EMG was used. Results. The most stable MEPs were recorded at mm. tibibalis anterior, mm. abductor hallucis longus. It has been proven that an unfavorable and reliable factor of the anxiety sign is a unilateral sustained decrease in the MEP amplitude by more than 80 %. According to the TSS results 424 (97.5 %) screws are installed correctly, 1 (0.2 %) false negative case of incorrect installation. False positive results for the TSS test ranged from 34.7 to 15.4 %, depending on the chosen critical threshold of the current applied to the pedicle screw. We consider the threshold of the TSS test at 13 mA satisfactory, and below it, unsatisfactory. A group of patients was identified who had 72 screws (16.6% of all analyzed) who, according to the results of the TSS test, received an unsatisfactory assessment, and X-ray did not reveal any deviations in the position of the screws.Conclusions. IOM modalities are highly sensitive and specific to damage to the structures of the spinal cord and spinal nerves, but dependence on a number of external factors reduces their information content, which leads to false positive and false negative results. It was established, that the dynamics of the MEP amplitudes of the target muscles differs in information content and efficiency during surgery due to individual morphological and motor characteristics.

Author Biographies

Oleksandr Barkov, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, PhD in Traumatology and Orthopаedics

Diana Duplii, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

PhD in Biol. Sci.

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How to Cite

Barkov, O., & Duplii, D. . (2023). PRACTICAL ASPECTS OF INTRAOPERATIVE NEUROMONITORING IN PATIENTS WITH DIFFERENT SPINAL PATHOLOGIES. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (4), 5–12. https://doi.org/10.15674/0030-5987202145-12

Issue

No. 4 (2021)

Section

ORIGINAL ARTICLES

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