Correlation between findings of intraoperative neurophysiological monitoring and clinical assessment in patients treated with anterior cervical discectomy and fusion

Degenerativne bolesti kičme nastaju kao posledica promena na dinamičkim segmentima kičmenog stuba. Klinički ove promene se mogu manifestovati u vidu radikulopatije, mijelopatije i radikulomijelopatije. Najčešće primenjivana metoda operativnog lečenja kod ovih pacijenata je prednja cervikalna diskektomija sa fuzijom koja omogućava adekvatnu anatomsku i funkcionalnu restituciju degenerativno promenjene cervikalne kičme. Imajući u vidu da su već kompromitovane nervne strukture u riziku od dodatnih oštećenja u različitim fazama operativnog zahvata primena intraoperativnog neurofiziološkog monitoringa je dobila svoje mesto i u hirurškim tretmanima degenerativnih oboljenja kičme. Svrha primene neuromonitoringa je da obezbedi povratnu informaciju hirurgu o promenama u funkciji nervnih struktura pre nego što dođe do ireverzibilnih oštećenja. Na ovaj način moguće je prevenirati nastanak novog ili pogoršanje postojećeg deficita. Takođe intraoperativni nalazi neurofizioloških parametara mogu da ukažu na težinu postojećeg oboljenja i da budu prediktori ishoda lečenja. Ciljevi ove doktorske disertacije bili su utvrđivanje faza operativnog zahvata u kojima najčešće dolazi do promena u neurofiziološkim parametrima, kao i postojanje korelacije nalaza intraoperativnog neurofiziološkog monitoringa sa preoperativnim kliničkim nalazom pacijenta kao i rezultatima procene ishoda nakon prednje cervikalne diskektomije se fuzijom. Ova studija je obuhvatila 30 pacijenata kod kojih je indikovano operativno lečenje degenerativnih promena u vratnom segmentu kičmenog stuba prednjom mikrodiskektomijom sa fuzijom. Preoperativno je izvođen klinički pregled pacijenata i korišteni su Numerička skala bola i Upitnik za pacijente sa bolom u vratnoj kičmi, koji su takođe popunjavani na otpustu i mesec dana nakon operacije. U toku hirurške procedure upotrebom intraoperativnog neurofiziološkog monitoringa registrovani su somatosenzorni (SSEP) i motorni evocirani potencijali (MEP), kao i spontana elektromiografija. Kod svih SSEP došlo je do statistički značajnog povećanja amplitude (p0,008). Latenca desnog n.medianusa pokazuje negativnu, a amplituda pozitivnu korelaciju sa vrednostima bola mesec dana postoperativno (p0.008). The right n.medianus latency shows a negative, and the amplitude shows positive correlation with pain values one month postoperatively (p<0.05). Increasing amplitude and shortening latency of the SSEP indicates a significant degree of decompression. The stability of the MEP indicates the intraoperative preservation of motor pathways and absence of both new motor deficiency or worsening of the existing one. SSEP and MEP correlate with clinical findings, while pain and NDI values are statistically significantly less after surgery. These results indicate that clinical findings in the patients correlate with the neurophysiological findings. Results also points out that the intraoperative changes in neurophysiological parameters can be a predictive factor for the outcome of surgical treatment

Correlation between findings of intraoperative neurophysiological monitoring and clinical assessment in patients treated with anterior cervical discectomy and fusion

Degenerativne bolesti kičme nastaju kao posledica promena na dinamičkim segmentima kičmenog stuba. Klinički ove promene se mogu manifestovati u vidu radikulopatije, mijelopatije i radikulomijelopatije. Najčešće primenjivana metoda operativnog lečenja kod ovih pacijenata je prednja cervikalna diskektomija sa fuzijom koja omogućava adekvatnu anatomsku i funkcionalnu restituciju degenerativno promenjene cervikalne kičme. Imajući u vidu da su već kompromitovane nervne strukture u riziku od dodatnih oštećenja u različitim fazama operativnog zahvata primena intraoperativnog neurofiziološkog monitoringa je dobila svoje mesto i u hirurškim tretmanima degenerativnih oboljenja kičme. Svrha primene neuromonitoringa je da obezbedi povratnu informaciju hirurgu o promenama u funkciji nervnih struktura pre nego što dođe do ireverzibilnih oštećenja. Na ovaj način moguće je prevenirati nastanak novog ili pogoršanje postojećeg deficita. Takođe intraoperativni nalazi neurofizioloških parametara mogu da ukažu na težinu postojećeg oboljenja i da budu prediktori ishoda lečenja. Ciljevi ove doktorske disertacije bili su utvrđivanje faza operativnog zahvata u kojima najčešće dolazi do promena u neurofiziološkim parametrima, kao i postojanje korelacije nalaza intraoperativnog neurofiziološkog monitoringa sa preoperativnim kliničkim nalazom pacijenta kao i rezultatima procene ishoda nakon prednje cervikalne diskektomije se fuzijom. Ova studija je obuhvatila 30 pacijenata kod kojih je indikovano operativno lečenje degenerativnih promena u vratnom segmentu kičmenog stuba prednjom mikrodiskektomijom sa fuzijom. Preoperativno je izvođen klinički pregled pacijenata i korišteni su Numerička skala bola i Upitnik za pacijente sa bolom u vratnoj kičmi, koji su takođe popunjavani na otpustu i mesec dana nakon operacije. U toku hirurške procedure upotrebom intraoperativnog neurofiziološkog monitoringa registrovani su somatosenzorni (SSEP) i motorni evocirani potencijali (MEP), kao i spontana elektromiografija. Kod svih SSEP došlo je do statistički značajnog povećanja amplitude (p0,008). Latenca desnog n.medianusa pokazuje negativnu, a amplituda pozitivnu korelaciju sa vrednostima bola mesec dana postoperativno (p0.008). The right n.medianus latency shows a negative, and the amplitude shows positive correlation with pain values one month postoperatively (p<0.05). Increasing amplitude and shortening latency of the SSEP indicates a significant degree of decompression. The stability of the MEP indicates the intraoperative preservation of motor pathways and absence of both new motor deficiency or worsening of the existing one. SSEP and MEP correlate with clinical findings, while pain and NDI values are statistically significantly less after surgery. These results indicate that clinical findings in the patients correlate with the neurophysiological findings. Results also points out that the intraoperative changes in neurophysiological parameters can be a predictive factor for the outcome of surgical treatment

Peak cardiac power output and cardiac reserve in sedentary men and women

Background and Purpose: Cardiac power output (CPO) and cardiac reserve (CR) are novel parameters of overall cardiac function. The purpose of this study was to determine differences in values of the CPO at rest and peak exercise and CR in sedentary men and women. Material and Methods: Thirty healthy men (age 21.2±0.7 years, body mass 63±6.3 kg, height 168.3±5.1 cm) and thirty healthy women (age 21.3±1.9 years, mass 82.5±7.9 kg, height 181.9±4.9 cm) were included in this study. Echocardiography was used to assess cardiac and hemodynamic parameters. CPO was calculated, at rest and after performed maximal bicycle test, as the product of cardiac output and mean arterial pressure, and CR as the difference of CPO value measured at peak exercise and at rest. Results: At rest, the two groups had similar values of cardiac power output (1.04±0.3W versus 1.14±0.25W, p>0.05). CPO after peak exercise was higher in men (5.1±0.72W versus 3.9±0.58W, p<0.05), as was cardiac reserve (3.96±0.64W versus 2.86±0.44W, p<0.05), respectively. After allometric scaling method was used to decrease the effect of body size on peak CPO, men still had significantly higher peak CPO (2.79±0.4 W m-2 versus 2.46±0.32 W m-2, p<0.05). At peak exercise, a significant positive relationship was found between cardiac power output and end diastolic volume (r=0.60), end diastolic left ventricular internal dimension (r=0.58), stroke volume (r=0.86) and cardiac output (r=0.87). Conclusion: The study showed that men had higher CPO after peak exercise and greater cardiac reserve than women, even after decreasing body size effect

Peak cardiac power output and cardiac reserve in sedentary men and women

Background and Purpose: Cardiac power output (CPO) and cardiac reserve (CR) are novel parameters of overall cardiac function. The purpose of this study was to determine differences in values of the CPO at rest and peak exercise and CR in sedentary men and women. Material and Methods: Thirty healthy men (age 21.2±0.7 years, body mass 63±6.3 kg, height 168.3±5.1 cm) and thirty healthy women (age 21.3±1.9 years, mass 82.5±7.9 kg, height 181.9±4.9 cm) were included in this study. Echocardiography was used to assess cardiac and hemodynamic parameters. CPO was calculated, at rest and after performed maximal bicycle test, as the product of cardiac output and mean arterial pressure, and CR as the difference of CPO value measured at peak exercise and at rest. Results: At rest, the two groups had similar values of cardiac power output (1.04±0.3W versus 1.14±0.25W, p>0.05). CPO after peak exercise was higher in men (5.1±0.72W versus 3.9±0.58W, p<0.05), as was cardiac reserve (3.96±0.64W versus 2.86±0.44W, p<0.05), respectively. After allometric scaling method was used to decrease the effect of body size on peak CPO, men still had significantly higher peak CPO (2.79±0.4 W m-2 versus 2.46±0.32 W m-2, p<0.05). At peak exercise, a significant positive relationship was found between cardiac power output and end diastolic volume (r=0.60), end diastolic left ventricular internal dimension (r=0.58), stroke volume (r=0.86) and cardiac output (r=0.87). Conclusion: The study showed that men had higher CPO after peak exercise and greater cardiac reserve than women, even after decreasing body size effect

The Effects of Regular Physical Activity and Playing Video Games on Reaction Time in Adolescents

Reaction time is of great importance in life. In both sports and video games, movements of participants are conditioned by different visual, acoustic and somatosensory signals. The aim of this research was to determine whether reaction time is influenced by regular physical activity and playing video games in adolescents. The study included 41 female and 26 male students, aged 10&ndash;14 years. Questionnaires about habits related to regular physical activity and playing video games were given to the examinees. Afterwards, the reaction time was determined for visual stimuli, via a computer program. The obtained results show that there is a statistically significant difference in the value of the reaction time of children who are regularly engaged in physical activity relative to those who play video games ((0.327 &plusmn; 0.081) s vs. (0.403 &plusmn; 0.137) s, p = 0.013), while there is no statistically significant difference in reaction time between children who equally participate in physical activity and video games ((0.386 &plusmn; 0.134) s) compared to those who regularly practice physical activity (p = 0.156), and those who only play video games (p = 0.610). Physical activity can decrease reaction time in children, but further studies are needed to elucidate the impact of regular physical activity and gaming on the developing adolescent brain