The interconnectedness of the motor and nociceptive systems in the conditions of operative correction of spinal deformity

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Abstract

BACKGROUND: The risk of complex neurological disorders after surgical correction of spinal deformity raises the question of the need for special measures for their postoperative treatment. This requires a more detailed study of the mechanisms of interaction between the motor sensory and autonomic structures of the nervous system.

AIM: The aim of the study is to search for a simple and informative method of testing the level of balance of the states of the motor and nociceptive systems in patients with spinal deformity of various etiologies in the conditions of its surgical treatment.

MATERIALS AND METHODS: A retrospective analysis of the results of electromiographic and esthesiometric examinations of 87 patients (30 male, 57 female) aged 15.6 ± 0.6 years with spinal deformities of various etiologies was carried out.

RESULTS: The scatterograms of the paired values of the electromyogram amplitude at the maximum voluntary tension m. tibialis anterior and the heat pain perception thresholds are best approximated by a polynomial of the third degree. But the approximation is acceptable only for electromyographic patterns with an unsaturated structure in the preoperative period. The nonlinear nature of the coupling of the intensity of the electrical activity of the muscle with the heat pain perception threshold contains a significant linear component. After surgical correction of spinal deformity, the approximation quality is reduced to a state of random noise. The reason for this is: postoperative increase in nociceptive activity and the consequences of anesthetic support.

CONCLUSIONS: In patients with spinal deformity, there is a correlation between the levels of voluntary muscle activity and the settings of the nociceptive system, expressed in the values of the heat pain thresholds. The nature of the coupling is expressed in the inverse relationship between the pain threshold and the amplitude of the electromyogram at maximum arbitrary voltage. This type of dependence is quite consistent with well-known physiological phenomena. The maximum severity of this interconnectedness for unsaturated patterns of the electromyogram indicates that the condition for its manifestation is a specific regime of stem centers that regulate the posture-tonic activity of muscles in patients with axial skeleton disorders.

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About the authors

Maksim A. Bogatyrev

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Author for correspondence.
Email: 270419920000dok@gmail.com
ORCID iD: 0000-0003-4637-2435

Postgraduate student

Russian Federation, 6 Marii Ulyanovoy St., Kurgan, 640014

Marat S. Saifutdinov

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Email: maratsaif@yandex.ru
ORCID iD: 0000-0002-7477-5250
SPIN-code: 2811-2992

Dr. Sci. (Biology), Leading Research Associate, Clinical Laboratory of the Clinic of Spine Pathology and Rare Diseases

Russian Federation, 6 Marii Ulyanovoy St., Kurgan, 640014

Elena N. Shchurova

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Email: elena.shurova@mail.ru
ORCID iD: 0000-0003-0816-1004
SPIN-code: 6919-1265

Dr. Sci. (Biology), Leading Research Associate, Clinical Laboratory of the Clinic of Spine Pathology and Rare Diseases

Russian Federation, 6 Marii Ulyanovoy St., Kurgan, 640014

Dmitry M. Savin

National Ilizarov Medical Research Centre for Traumatology and Orthopaedics

Email: savindm81@mail.ru
ORCID iD: 0000-0001-6284-2850
SPIN-code: 2155-2581

MD, Cand. Sci. (Medicine), neurosurgeon, orthopaedic trauma surgeon, Head of Trauma-Orthopfedic Department No. 9 of the Clinic of Spine Pathology and Rare Diseases

Russian Federation, 6 Marii Ulyanovoy St., Kurgan, 640014

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2. Fig. 1. The percentage ( n / N ) of unsaturated patterns of electrical activity of m. tibialis anterior before and after surgery for the entire sample (ALL) in idiopathic scoliosis (I), congenital spinal deformity (II) and deformities of other origin (III)

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3. Fig. 2. A scatterogram reflecting the nature of the relationship between the thresholds of pain from hot (T°) and the amplitude (A ЭМГ ) of unsaturated patterns of electrical activity of m. tibialis anterior in preoperative examination. Trend line A is an approximation of the data using a third degree polynomial (solid line), trend line B is a linear equation (broken line)

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