NEUROMONITORING DURING SPINE SURGERY, ALMATY (KAZAKHSTAN) EXPERIENCE

Dusembekov E., Aliev M., Sadykova Z., Zhaylaubaeva A., Mustafinov D.
Kazakh Medical University of Continuing Education, Almaty, Kazakhstan Clinical Hospital No7, Almaty, Kazakhstan
 
Keywords: spine surgery, spinal meningioma, spine intradural neuroma, spinal cord neuromonitoring, somatosensory evoked potentials, motor evoked potentials. Introduction. The use of intraoperative neuromonitoring (IOM) helps surgeon to detect and to prevent the damage of the nervous structures. The purpose of the study is to show our experience of using IOM during the spine operations. Methods. In this research analyzed clinical cases (2015-2016 yy) of spinal pathology at the Department of Spine Neurosurgery in the City Clinical Hospital No7 of Almaty. IOM conducted during operations: microsurgical removal of spinal cord tumors, transpedicular fusion. The following type of IOM has been used: trancranial motor evoked potentials (stimulation with 300-350 mA), somatosensory evoked potentials (with 10-12 mA). Spinal cord monitoring controlled the proximity of the nerve root, the conduction of spinal cord and during the fusion - accurate placement of pedicle screws. Results. A total of 35 patients were operated: twenty-
five spinal cord tumor resection, ten transpedicular fixation. Age of patients was 29-73 years old. According to nosology all patients were distributed in the following way: degenerative diseases of the spine-8, vertebral fractures-2, extramedullary tumors-21 (meningiomas-12, neuromas-9), intramedullary tumors-4. Damage of the nerve structures was observed at the levels: cervical-14,2% (5 patients), lumbar-37,1% (13), thoracic-48,6% (17). In the early postoperative period there was no worsening of neurological deficits. Pain stopped in 85% cases, improvement of motor function-in 47 to 91%, depression of neurological dysfunction of pelvic organ in 80%, regression of myelopathy syndrome – 77%. Saving neurological deficit on pre-operational level was in 2 patients (5,7%). Conclusion. Application of IOM improves clinical outcomes of operations, through the timely prevention of neurological deficits.
 

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