Publication: Estudio experimental de la monitorización neurofisiológica intraoperatoria en lesiones medulares
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2018-04-11
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Universidad Complutense de Madrid
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Abstract
Las lesiones en la médula espinal suponen un gran impacto tanto para el paciente como para su familia. El déficit funcional ocasionado por el daño medular depende del grado de afectación de las vías espinales. Sin embargo, no es la única variable que se ha de tener en cuenta. El deterioro medular está en clara relación con el nivel metamérico afecto, originando una destrucción de las funciones motoras, sensoriales y autonómicas por debajo de la lesión. La monitorización neurofisiológica intraoperatoria es una disciplina en constante evolución, que tiene como propósito localizar y vigilar la integridad funcional de todas las estructuras nerviosas y preservar su estado. La capacidad de recuperación tras una lesión de la médula espinal sigue siendo poco conocida y la prevención constituye el único mecanismo válido para salvaguardar su funcionalidad. Diversos estudios multicéntricos han revelado una reducción importante de la incidencia de lesión neurológica durante la cirugía de la columna en los casos en los que se empleaba la monitorización neurofisiológica de la función medular Los pacientes con lesión medular con frecuencia requieren tratamiento quirúrgico urgente. En estos casos, el tratamiento quirúrgico sin el empleo de monitorización neurofisiológica intraoperatoria puede no resolver el daño evolutivo, producir lesiones medulares adicionales o agravar la lesión medular previa. La posibilidad de identificar y cuantificar el daño producido y el territorio afectado en un tiempo adecuado para que el tratamiento o la corrección puedan ser implementadas, antes de que la lesión se instaure de forma permanente, predice una ruta esperanzadora para la investigación, con objeto de poder desarrollar un método objetivo de diagnóstico que permita localizar el nivel medular que se encuentra dañado...
Spinal cord injuries entail a major impact for both the patient and his family. The functional deficit caused by spinal cord injury depends on the degree of spinal pathway involvement. However, it is not the only variable that has to be taken into account. The medullary deterioration is clearly related to the affected metameric level, causing a destruction of the motor, sensorial and autonomic functions below the lesion. Intraoperative neurophysiological monitoring is a constantly evolving discipline, whose purpose is to locate and monitor the functional integrity of all nerve structures and to preserve their condition. Recovery following spinal cord injury remains little known and prevention is the only valid mechanism to safeguard its functionality. Several multicenter studies have revealed a reduction in the incidence of neurological injury during spinal surgery in cases where neurophysiological monitoring of spinal function is used. Patients with spinal cord injury often require urgent surgical treatment. In these cases, surgical treatment without the use of intraoperative neurophysiological monitoring may not resolve the evolutionary damage, cause additional spinal cord injuries or aggravate the previous spinal cord injury. The possibility of identifying and quantifying the damage done and the affected territory in a timely manner so that the treatment or correction can be implemented, before the injury is permanently established, predicts a promising route for investigation, in order to be able to develop an objective method of diagnosis that allows to locate the marrow level that is damaged...
Spinal cord injuries entail a major impact for both the patient and his family. The functional deficit caused by spinal cord injury depends on the degree of spinal pathway involvement. However, it is not the only variable that has to be taken into account. The medullary deterioration is clearly related to the affected metameric level, causing a destruction of the motor, sensorial and autonomic functions below the lesion. Intraoperative neurophysiological monitoring is a constantly evolving discipline, whose purpose is to locate and monitor the functional integrity of all nerve structures and to preserve their condition. Recovery following spinal cord injury remains little known and prevention is the only valid mechanism to safeguard its functionality. Several multicenter studies have revealed a reduction in the incidence of neurological injury during spinal surgery in cases where neurophysiological monitoring of spinal function is used. Patients with spinal cord injury often require urgent surgical treatment. In these cases, surgical treatment without the use of intraoperative neurophysiological monitoring may not resolve the evolutionary damage, cause additional spinal cord injuries or aggravate the previous spinal cord injury. The possibility of identifying and quantifying the damage done and the affected territory in a timely manner so that the treatment or correction can be implemented, before the injury is permanently established, predicts a promising route for investigation, in order to be able to develop an objective method of diagnosis that allows to locate the marrow level that is damaged...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 12/06/2017