Практичні аспекти інтраопераційного нейромоніторингу у хворих із різною патологією хребта.

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 Xray 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. [ABSTRACT FROM AUTHOR]