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Kyphosis - A risk factor for positioning brachial plexopathy during spinal surgeries.

Artikel i vetenskaplig tidskrift
Författare Mirza Biscevic
Aida Sehic
Sejla Biscevic
Ismet Gavrankapetanovic
Barbara Smrke
Damir Vukomanovic
Ferid Krupic
Publicerad i Acta orthopaedica et traumatologica turcica
Volym 53
Nummer/häfte 3
Sidor 199-202
ISSN 2589-1294
Publiceringsår 2019
Publicerad vid Institutionen för kliniska vetenskaper, Avdelningen för ortopedi
Sidor 199-202
Språk en
Länkar dx.doi.org/10.1016/j.aott.2019.02.0...
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Ortopedi

Sammanfattning

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.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.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.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 IV Therapeutic Study.

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