Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries
Objective: The aim of this study was to evaluate the differences in transcranial electric motor-evoked potentials – TceMEP on upper limbs and the incidences of postoperative brachial plexopathy between patients with kyphotic and scoliotic trunk shapes. Methods: In the period of January 2011–January...
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| Format: | Article |
| Language: | English |
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AVES
2019-05-01
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| Series: | Acta Orthopaedica et Traumatologica Turcica |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1017995X17300202 |
| _version_ | 1797908993853620224 |
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| author | Mirza Biscevic Aida Sehic Sejla Biscevic Ismet Gavrankapetanovic Barbara Smrke Damir Vukomanovic Ferid Krupic |
| author_facet | Mirza Biscevic Aida Sehic Sejla Biscevic Ismet Gavrankapetanovic Barbara Smrke Damir Vukomanovic Ferid Krupic |
| author_sort | Mirza Biscevic |
| collection | DOAJ |
| description | Objective: The aim of this study was to evaluate the differences in transcranial electric motor-evoked potentials – TceMEP on upper limbs and the incidences of postoperative brachial plexopathy between patients with kyphotic and scoliotic trunk shapes. Methods: In the period of January 2011–January 2017, 61 consecutive patients (mean age: 18.4 years ± 4.4 years (range: 10–32)) with pediatric spinal deformity underwent surgery in our Department. Eight of them had a kyphotic trunk deformity (Scheuermann kyphosis, neurofibromatosis, posterior thoracic hemivertebra), and the rest of the 53 patients had a scoliotic trunk deformity (mostly adolescent idiopathic scoliosis – AIS, lateral hemivertebra). The TceMEP recordings in all four limbs were analyzed every 30 min, or upon the surgeon's command. Upper limb TceMEP recordings were used as a control of systemic and anesthetic related changes, and as the indicator of positioning brachial plexopathy. Results: Four out of 8 patients (50.0%) from the kyphotic group experienced noteworthy decreases in TceMEP amplitude (≥65%) in one or both arms, and only 2 out of 53 patients (3.8%) from the scoliotic group, confirming significant statistical difference (Chi-square 16.75, p < 0.05). Two out of 8 patients with decreases in TceMEP amplitude suffered from transitory postoperative brachial plexopathy, and both of them were from the kyphotic group. Conclusion: It seems that kyphotic trunks have a higher risk for positioning-related brachial plexopathy, probably due to distribution of trunk's weight onto only four points (two iliac bones and two shoulders), compared to the scoliotic trunks that have wider weight-bearing areas. We emphasize the importance of proper patient positioning and close intraoperative neuro-monitoring of all four limbs in more than one channel per limb. Level of Evidence: Level IV Therapeutic Study. Keywords: Brachial plexopathy, Motor-evoked potentials, Spine deformity, Trunk, Kyphosis, Scoliosis |
| first_indexed | 2024-04-10T11:01:29Z |
| format | Article |
| id | doaj.art-db4a066f5556456cbc9393c66083745a |
| institution | Directory Open Access Journal |
| issn | 1017-995X |
| language | English |
| last_indexed | 2024-04-10T11:01:29Z |
| publishDate | 2019-05-01 |
| publisher | AVES |
| record_format | Article |
| series | Acta Orthopaedica et Traumatologica Turcica |
| spelling | doaj.art-db4a066f5556456cbc9393c66083745a2023-02-15T16:19:38ZengAVESActa Orthopaedica et Traumatologica Turcica1017-995X2019-05-01533199202Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeriesMirza Biscevic0Aida Sehic1Sejla Biscevic2Ismet Gavrankapetanovic3Barbara Smrke4Damir Vukomanovic5Ferid Krupic6Department of Orthopedics and Traumatology, General Hospital Sarajevo, Bosnia and Herzegovina; Corresponding author. Department of Orthopedics and Traumatology, General Hospital Sarajevo, Kranjceviceva 12, 71000 Sarajevo, Bosnia and Herzegovina. Tel.: +0038733285100. Fax: +0038733285370.Department of Intraoperative Neurophysiological Monitoring, SMS, Louisville, KY, USADepartment of Nuclear Medicine, General Hospital Sarajevo, Bosnia and HerzegovinaDepartment of Orthopedics and Traumatology, General Hospital Sarajevo, Bosnia and HerzegovinaDepartment of Neurosurgery, Clinical Center Ljubljana, SloveniaGeorge Washington University School of Medicine and Health Sciences, USADepartment of Orthopedics, Sahlgrenska Academy at University of Gothenburg, SwedenObjective: The aim of this study was to evaluate the differences in transcranial electric motor-evoked potentials – TceMEP on upper limbs and the incidences of postoperative brachial plexopathy between patients with kyphotic and scoliotic trunk shapes. Methods: In the period of January 2011–January 2017, 61 consecutive patients (mean age: 18.4 years ± 4.4 years (range: 10–32)) with pediatric spinal deformity underwent surgery in our Department. Eight of them had a kyphotic trunk deformity (Scheuermann kyphosis, neurofibromatosis, posterior thoracic hemivertebra), and the rest of the 53 patients had a scoliotic trunk deformity (mostly adolescent idiopathic scoliosis – AIS, lateral hemivertebra). The TceMEP recordings in all four limbs were analyzed every 30 min, or upon the surgeon's command. Upper limb TceMEP recordings were used as a control of systemic and anesthetic related changes, and as the indicator of positioning brachial plexopathy. Results: Four out of 8 patients (50.0%) from the kyphotic group experienced noteworthy decreases in TceMEP amplitude (≥65%) in one or both arms, and only 2 out of 53 patients (3.8%) from the scoliotic group, confirming significant statistical difference (Chi-square 16.75, p < 0.05). Two out of 8 patients with decreases in TceMEP amplitude suffered from transitory postoperative brachial plexopathy, and both of them were from the kyphotic group. Conclusion: It seems that kyphotic trunks have a higher risk for positioning-related brachial plexopathy, probably due to distribution of trunk's weight onto only four points (two iliac bones and two shoulders), compared to the scoliotic trunks that have wider weight-bearing areas. We emphasize the importance of proper patient positioning and close intraoperative neuro-monitoring of all four limbs in more than one channel per limb. Level of Evidence: Level IV Therapeutic Study. Keywords: Brachial plexopathy, Motor-evoked potentials, Spine deformity, Trunk, Kyphosis, Scoliosishttp://www.sciencedirect.com/science/article/pii/S1017995X17300202 |
| spellingShingle | Mirza Biscevic Aida Sehic Sejla Biscevic Ismet Gavrankapetanovic Barbara Smrke Damir Vukomanovic Ferid Krupic Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries Acta Orthopaedica et Traumatologica Turcica |
| title | Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries |
| title_full | Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries |
| title_fullStr | Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries |
| title_full_unstemmed | Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries |
| title_short | Kyphosis – A risk factor for positioning brachial plexopathy during spinal surgeries |
| title_sort | kyphosis a risk factor for positioning brachial plexopathy during spinal surgeries |
| url | http://www.sciencedirect.com/science/article/pii/S1017995X17300202 |
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