A comparative study of the data of intraoperative neurophysiological monitoring in the surgical correction of severe scoliosis with and without preoperative halo-traction

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

BACKGROUND: Intraoperative neurophysiological monitoring (IONM) in remedial spine surgery is currently a gold standard, and protecting the nervous system during surgery is a major concern for both surgeons and patients. Moreover, we use various types of preoperative halo traction in patients with severe scoliosis to reduce the risk of neurological complications. Thus, we performed a comparative study of changes in IONM findings during scoliosis surgery in patients with and without preoperative halo-gravity traction.

AIM: To compare IONM findings during scoliosis surgery with and without preoperative halo-gravity traction.

MATERIALS AND METHODS: An observational, single-center, retrospective, single-arm study of IONM findings was performed in 88 patients with severe scoliosis who underwent scoliosis surgery with halo traction between 2019 and 2023. The study included two groups. Group 1 (52 patients) had preoperative halo-gravity traction while standing or sitting. Group 2 (36 patients) had intraoperative halo traction. A comparative analysis was performed, which included the following: risk criteria for neurological deficit in the lower extremities during surgery, deformation angles, mobility parameters, postoperative deformation, blood loss, and surgery duration.

RESULTS: The intergroup comparison of changes in deformation angles and IONM findings revealed that Group 1 had more severe deformation based on primary and compensatory curve angles, more severe stiffness, and a lower number of patients with normal motor evoked potential (MEP) levels. The differences were significant (p <0.05). Risk criteria for neurological deficit were reported in 12 patients: seven in Group 1 and five in Group 2. In two patients in Group 2, MEP values of the lower extremities were not restored, resulting in permanent neurological deficit.

CONCLUSION: Preoperative halo traction prepares the nervous structures for the treatment of severe deformations and minimizes the intraoperative impact on the nervous system, reducing the risk of neurological complications in patients with severe spinal deformities compared to immediate treatment with intraoperative traction.

About the authors

Samir B. Bagirov

Priorov National Medical Research Center of Traumatology and Orthopedics

Author for correspondence.
Email: bagirov.samir22@gmail.com
ORCID iD: 0000-0003-1038-1815
SPIN-code: 9620-7038

MD

Russian Federation, 10 Priorova str., 127299 Moscow

Sergey V. Kolesov

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: dr-kolesov@yandex.ru
ORCID iD: 0000-0001-9657-8584
SPIN-code: 1989-6994

MD, Dr. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127299 Moscow

Evgeny V. Gulayev

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: evlgul@mail.ru
ORCID iD: 0000-0002-3464-8927

MD

Russian Federation, 10 Priorova str., 127299 Moscow

Vladimir V. Shvec

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: vshvetcv@yandex.ru
ORCID iD: 0000-0001-8884-2410

MD, Dr. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127299 Moscow

Natalia S. Morozova

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: morozcito@gmail.com
ORCID iD: 0000-0003-4504-6902
SPIN-code: 4593-3231

MD, Cand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127299 Moscow

Vladimir S. Pereverzev

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: vcpereverz@gmail.com
ORCID iD: 0000-0002-6895-8288
SPIN-code: 8164-1389

MD, Cand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127299 Moscow

Arkady I. Kazmin

Priorov National Medical Research Center of Traumatology and Orthopedics

Email: kazmin.cito@mail.ru
ORCID iD: 0000-0003-2330-0172
SPIN-code: 4944-4173

MD, Cand. Sci. (Medicine)

Russian Federation, 10 Priorova str., 127299 Moscow

Victor B. Shamik

Rostov State Medical University

Email: prof.shamik@gmail.com
ORCID iD: 0000-0002-0461-8700
SPIN-code: 2977-6446

MD, Dr. Sci. (Medicine)

Russian Federation, Rostov-on-Don

References

  1. Fabregas N, Gomar C. Monitoring in neuroanaesthesia: update of clinical usefulness. Eur J Anaesthesiol. 2001;18(7):423–439. doi: 10.1046/j.1365-2346.2001.00856.x
  2. Padberg AM, Russo MH, Lenke LG, Bridwell KH, Komanetsky RM. Validity and reliability of spinal cord monitoring in neuromuscular spinal deformity surgery. J Spinal Disord. 1996;9(2):150–158.
  3. Padberg AM, Wilson-Holden TJ, Lenke LG, Bridwell KH. Somatosensory- and motor-evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery. An accepted standard of care. Spine (Phila Pa 1976). 1998;23(12):1392–1400. doi: 10.1097/00007632-199806150-00018
  4. Pereon Y, Nguyen The Tich, Delecrin J, Passuti N. Somatosensory- and motor-evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery: an accepted standard of care. Spine (Phila Pa 1976). 1999;24(11):1169–1170. doi: 10.1097/00007632-199906010-00021
  5. Sala F, Krzan MJ, Deletis V. Intraoperative neurophysiological monitoring in pediatric neurosurgery: why, when, how? Childs Nerv Syst. 2002;18(6–7):264–287. doi: 10.1007/s00381-002-0582-3
  6. Kinney GA, Slimp JC. Intraoperative neurophysiological monitoring technology: recent advances and evolving uses. Expert Rev Med Devices. 2007;4(1):33–41. doi: 10.1586/17434440.4.1.33
  7. Gonzalez AA, Jeyanandarajan D, Hansen C, Zada G, Hsieh PC. Intraoperative neurophysiological monitoring during spine surgery: a review. Neurosurg Focus. 2009;27(4):E6. doi: 10.3171/2009.8.FOCUS09150
  8. Biscevic M, Sehic A, Krupic F. Intraoperative neuromonitoring in spine deformity surgery: modalities, advantages, limitations, medicolegal issues — surgeons’ views. EFORT Open Rev. 2020;5(1):9–16. doi: 10.1302/2058-5241.5.180032
  9. Chen B, Chen Y, Yang J, et al. Comparison of the Wake-up Test and Combined TES-MEP and CSEP Monitoring in Spinal Surgery. J Spinal Disord Tech. 2015;28(9):335–40. doi: 10.1097/BSD.0b013e3182aa736d
  10. Lall RR, Lall RR, Hauptman JS, et al. Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist. Neurosurg Focus. 2012;33(5):E10. doi: 10.3171/2012.9.FOCUS12235
  11. Strahm C, Min K, Boos N, Ruetsch Y, Curt A. Reliability of perioperative SSEP recordings in spine surgery. Spinal Cord. 2003;41(9):483–9. doi: 10.1038/sj.sc.3101493
  12. McIntosh AL, Ramo BS, Johnston CE. Halo Gravity Traction for Severe Pediatric Spinal Deformity: A Clinical Concepts Review. Spine Deform. 2019;7(3):395–403. doi: 10.1016/j.jspd.2018.09.068
  13. Shi B, Liu D, Shi B, et al. A Retrospective Study to Compare the Efficacy of Preoperative Halo-Gravity Traction and Postoperative Halo-Femoral Traction After Posterior Spinal Release in Corrective Surgery for Severe Kyphoscoliosis. Med Sci Monit. 2020;26:e919281. doi: 10.12659/MSM.919281
  14. Yang C, Wang H, Zheng Z, et al. Halo-gravity traction in the treatment of severe spinal deformity: a systematic review and meta-analysis. Eur Spine J. 2017;26(7):1810–1816. doi: 10.1007/s00586-016-4848-y
  15. Kuleshov AA. Severe forms of scoliosis. Surgical treatment and functional features of some organs and systems [dissertation]. Moscow; 2007. 252–255 p. Available from: https://www.dissercat.com/content/tyazhelye-formy-skolioza-operativnoe-lechenie-i-funktsionalnye-osobennosti-nekotorykh-organo?ysclid=lp5ogu1eyk942975917 (In Russ.).
  16. Halsey MF, Myung KS, Ghag A, et al. Neurophysiological monitoring of spinal cord function during spinal deformity surgery: 2020 SRS neuromonitoring information statement. Spine Deform. 2020;8(4):591–596. doi: 10.1007/s43390-020-00140-2
  17. Kuzmina VA, Syundyukov AR, Nikolaev NS, Mikhailova IV, Nikolaeva AV. Experience in the use of intraoperative neurophysiological monitoring during spinal surgery Orthopedics, traumatology and reconstructive surgery for children. 2016;4(4):33–40. (In Russ.). doi: 10.17816/PTORS4433-40
  18. Mikhailovsky MV, Sadovoy MA. Surgical treatment of scoliotic disease. Results, outcomes. Novosibirsk: NSU Publishing House; 1993. 192 p. (In Russ.). EDN: ZQYGAD
  19. Novikov VV, Novikova MV, Tsvetovsky SB, et al. Prevention of neurological complications during surgical correction of gross spinal deformities. Spinal surgery. 2011;(3):066–076. (In Russ.). doi: 10.14531/ss2011.3.66-76
  20. Bardosi L, Illes T. Neurological complication due to epidural hematoma after СD operations. Case report. In: Neurological Complications of Spinal Surgery. Proceedings of the 11th International GICD Congress. Arcachon, France; 1994. Р. 60–62.
  21. Bridwell KH, Lenke LG, Baldus C, et al. Major intraoperative neurologic deficits in pediatric and adult spinal deformity patients. Incidence and etiology at one institution. Spine (Phila Pa 1976). 1998;23(3):324–331. doi: 10.1097/00007632-199802010-00008
  22. Koller H, Zenner J, Gajic V, et al. The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis: a clinical study and narrative review of the literature. Eur Spine J. 2012;21(3):514–29. doi: 10.1007/s00586-011-2046-5
  23. Mechin JF. Neurological complications with CDI. In: Neurological Complications of Spinal Surgery. Proceedings of the 11th International GICD Congress. Arcachon, France; 1994. Р. 9–11.
  24. Diab M, Smith AR, Kuklo TR. Neural complications in the surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2007;32(24):2759–2763. doi: 10.1097/BRS.0b013e31815a5970
  25. Bartley CE, Yaszay B, Bastrom TP, et al. Perioperative and delayed major complications following surgical treatment of adolescent idiopathic scoliosis. J Bone Jt Surg Am. 2017;99(14):1206–1212. doi: 10.2106/JBJS.16.01331
  26. Glover CD, Carling NP. Neuromonitoring for scoliosis surgery. Anesthesiol Clin. 2014;32(1):101–14. doi: 10.1016/j.anclin.2013.10.001
  27. Qiu Y, Wang S, Wang B, et al. Incidence and risk factors of neurological deficits of surgical correction for scoliosis: analysis of 1373 cases at one Chinese institution. Spine (Phila Pa 1976). 2008;33(5):519–26. doi: 10.1097/BRS.0b013e3181657d93
  28. Dawson EG, Sherman JE, Kanim LE, Nuwer MR. Spinal cord monitoring. Results of the Scoliosis Research Society and the European Spinal Deformity Society survey. Spine (Phila Pa 1976). 1991;16(8 Suppl):S361–4.
  29. Burton DC, Carlson BB, Place HM, et al. Results of the scoliosis research society morbidity and mortality database 2009–2012: a report from the morbidity and mortality committee. Spine Deform. 2016;4(5):338–343. doi: 10.1016/j.jspd.2016.05.003
  30. MacEwen GD, Bunnell WP, Sriram K. Acute neurological complications in the treatment of scoliosis: a report of the Scoliosis Research Society. J Bone Jt Surg Am. 1975;57:404–408.
  31. Schmitt EW. Neurological complications in the treatment of scoliosis. A sequential report of the Scoliosis Research Society 1971–1979. In: Reported at the 17th annual meeting of the Scoliosis Research Society. Denver; 1981.
  32. Wilber RG, Thompson GH, Shafer JW, et al. Post-operative neurological deficits in segmental spinal instrumentation. J Bone Jt Surg Am. 1984;66:1178–1187.
  33. Boachie-Adjei O, Yagi M, Nemani VM, et al. Incidence and risk factors for major surgical complications in patients with complex spinal deformity: a report from an SRS GOP Site. Spine Deform. 2015;3(1):57–64. doi: 10.1016/j.jspd.2014.06.008
  34. Coe JD, Arlet V, Donaldson W, et al. Complications in spinal fusion for adolescent idiopathic scoliosis in the new millennium. A report of the Scoliosis Research Society Morbidity and Mortality Committee. Spine (Phila Pa 1976). 2006;31(3):345–9. doi: 10.1097/BSD.0b013e3182aa736d
  35. Ghobrial GM, Williams KA Jr, Arnold P, Fehlings M, Harrop JS. Iatrogenic neurologic deficit after lumbar spine surgery: A review. Clin Neurol Neurosurg. 2015;139:76–80. doi: 10.1016/j.clineuro.2015.08.022
  36. Araus-Galdos E, Delgado P, Villalain C, et al. Prevention of brachial plexus injury due to positioning of patient in spinal surgery. Value of multimodal intraoperative neuromonitoring (IONM). Clinical Neurophysiology. 2011;122:S113.
  37. Thirumala PD, Huang J, Thiagarajan K, et al. Diagnostic Accuracy of Combined Multimodality Somatosensory Evoked Potential and Transcranial Motor Evoked Potential Intraoperative Monitoring in Patients With Idiopathic Scoliosis. Spine (Phila Pa 1976). 2016;41(19):E1177–E1184. doi: 10.1097/BRS.0000000000001678
  38. Baklaushev VP, Durov OV, Kim SV, et al. Development of a motor and somatosensory evoked potentials-guided spinal cord Injury model in non-human primates. J Neurosci Methods. 2019;311:200–214. doi: 10.1016/j.jneumeth.2018.10.030
  39. Rao JS, Zhao C, Zhang A, et al. NT3-chitosan enables de novo regeneration and functional recovery in monkeys after spinal cord injury. Proc Natl Acad Sci U S A. 2018;115(24):E5595–E5604. doi: 10.1073/pnas.1804735115
  40. Da Cunha RJ, Al Sayegh S, LaMothe JM, et al. Intraoperative skull-femoral traction in posterior spinal arthrodesis for adolescent idiopathic scoliosis: the impact on perioperative outcomes and health resource utilization. Spine (Phila Pa 1976). 2015;40(3):E154–60. doi: 10.1097/BRS.0000000000000711
  41. Peiro-Garcia A, Brown GE, Earp MA, Parsons D, Ferri-de-Barros F. Sagittal Balance in Adolescent Idiopathic Scoliosis Managed With Intraoperative Skull Femoral Traction. Clin Spine Surg. 2019;32(10):E474–E478. doi: 10.1097/BSD.0000000000000854
  42. Erdem MN, Oltulu I, Karaca S, Sari S, Aydogan M. Intraoperative Halo-Femoral Traction in Surgical Treatment of Adolescent Idiopathic Scoliosis Curves between 70° and 90°: Is It Effective? Asian Spine J. 2018;12(4):678–685. doi: 10.31616/asj.2018.12.4.678
  43. Rushton PRP, Aldebeyan S, Ghag R, et al. What is the effect of intraoperative traction on correction of adolescent idiopathic scoliosis (AIS)? Spine Deform. 2021;9(6):1549–1557. doi: 10.1007/s43390-021-00369-5
  44. Lewis SJ, Gray R, Holmes LM, et al. Neurophysiological changes in deformity correction of adolescent idiopathic scoliosis with intraoperative skull-femoral traction. Spine (Phila Pa 1976). 2011;36(20):1627–38. doi: 10.1097/BRS.0b013e318216124e

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Sex and age characteristics of patients (quantitative ratio).

Download (90KB)
Indexing metadata
3. Fig. 2. Needle electrode installed in the abductor hallucis of the right foot.

Download (154KB)
Indexing metadata
4. Fig. 3. Neurophysiological monitoring data during surgical treatment.

Download (750KB)
Indexing metadata
5. Fig. 4. Preoperative neurological deficit in both groups. Note. ПГТ — preoperative halo-traction, ИОГТ — intraoperative halo-traction.

Download (153KB)
Indexing metadata
6. Fig. 5. Intraoperative alarms of intraoperative neurophysiological monitoring.

Download (99KB)
Indexing metadata
7. Fig. 6. Postoperative deficit depending on the number of alarms.

Download (100KB)
Indexing metadata

Copyright (c) 2024 Eco-Vector

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Согласие на обработку персональных данных с помощью сервиса «Яндекс.Метрика»

1. Я (далее – «Пользователь» или «Субъект персональных данных»), осуществляя использование сайта https://journals.rcsi.science/ (далее – «Сайт»), подтверждая свою полную дееспособность даю согласие на обработку персональных данных с использованием средств автоматизации Оператору - федеральному государственному бюджетному учреждению «Российский центр научной информации» (РЦНИ), далее – «Оператор», расположенному по адресу: 119991, г. Москва, Ленинский просп., д.32А, со следующими условиями.

2. Категории обрабатываемых данных: файлы «cookies» (куки-файлы). Файлы «cookie» – это небольшой текстовый файл, который веб-сервер может хранить в браузере Пользователя. Данные файлы веб-сервер загружает на устройство Пользователя при посещении им Сайта. При каждом следующем посещении Пользователем Сайта «cookie» файлы отправляются на Сайт Оператора. Данные файлы позволяют Сайту распознавать устройство Пользователя. Содержимое такого файла может как относиться, так и не относиться к персональным данным, в зависимости от того, содержит ли такой файл персональные данные или содержит обезличенные технические данные.

3. Цель обработки персональных данных: анализ пользовательской активности с помощью сервиса «Яндекс.Метрика».

4. Категории субъектов персональных данных: все Пользователи Сайта, которые дали согласие на обработку файлов «cookie».

5. Способы обработки: сбор, запись, систематизация, накопление, хранение, уточнение (обновление, изменение), извлечение, использование, передача (доступ, предоставление), блокирование, удаление, уничтожение персональных данных.

6. Срок обработки и хранения: до получения от Субъекта персональных данных требования о прекращении обработки/отзыва согласия.

7. Способ отзыва: заявление об отзыве в письменном виде путём его направления на адрес электронной почты Оператора: info@rcsi.science или путем письменного обращения по юридическому адресу: 119991, г. Москва, Ленинский просп., д.32А

8. Субъект персональных данных вправе запретить своему оборудованию прием этих данных или ограничить прием этих данных. При отказе от получения таких данных или при ограничении приема данных некоторые функции Сайта могут работать некорректно. Субъект персональных данных обязуется сам настроить свое оборудование таким способом, чтобы оно обеспечивало адекватный его желаниям режим работы и уровень защиты данных файлов «cookie», Оператор не предоставляет технологических и правовых консультаций на темы подобного характера.

9. Порядок уничтожения персональных данных при достижении цели их обработки или при наступлении иных законных оснований определяется Оператором в соответствии с законодательством Российской Федерации.

10. Я согласен/согласна квалифицировать в качестве своей простой электронной подписи под настоящим Согласием и под Политикой обработки персональных данных выполнение мною следующего действия на сайте: https://journals.rcsi.science/ нажатие мною на интерфейсе с текстом: «Сайт использует сервис «Яндекс.Метрика» (который использует файлы «cookie») на элемент с текстом «Принять и продолжить».