Intraoperative response of the pyramidal system to surgical correction of spinal deformities of various etiologies

Abstract

Objective. To assess the information value of comparing the results of formalizing intraoperative changes in transcranial motor evoked potentials during surgical correction of spinal deformities of various etiologies. Material and Methods. Study design: analysis of monocentric retrospective unselected cohort over 5 years, evidence class 2b. Surgical correction of spinal deformity under neurophysiological control was performed in 364 patients (mean age 12.80 ± 0.40 years). The scores of changes in motor evoked potentials were used to compare the pyramidal system response to surgical aggression in patients with congenital spinal deformities, idiopathic scoliosis, and systemic skeletal diseases. Results. Basic motor responses in patients with systemic diseases of the axial skeleton are to a greater extent depressed and unstable than in those with congenital deformity and idiopathic scoliosis. On surgery completion, these differences are exacerbated. Five identified types of response of the spinal cord conduction pathways to surgical correction of spinal deformity allow comparing intraoperative neuromonitoring results in different groups of patients. The most dangerous types of response are observed more often in patients with congenital and systemic pathologies than in those with idiopathic scoliosis. Conclusion. The proposed method for the rank assessment of intraoperative changes in motor evoked potentials during surgical correction of spinal deformity allows comparative studies of patients’ reactions to surgical intervention in different etiological and age groups. The greatest risk of iatrogenic motor disorders in the postoperative period is observed in patients with systemic skeletal pathology.

Keywords

• spine deformity
• spinal surgery
• intraoperative neuromonitoring
• pyramidal system
• neurological complications