Łukasz Kubaszewski

The evaluation of patients after the surgical correction of idiopathic scoliosis in a long-term follow-up with clinical neurophysiological methods has not been presented in detail. This study aimed to compare the results of neurophysiological studies in 45 girls with scoliosis of Lenke types 1–3 performed pre- (T0) and postoperatively, 1 week after surgery (T1) and 6 months after surgery (T2). The parameter values of the surface electromyography while attempting maximal contraction (mcsEMG) and the transcranial motor-evoked potentials (MEPs) recorded in the anterior tibial muscles, as well as the electroneurography (ENG) of the peripheral transmission in the peroneal nerve motor fibers, were compared. The results indicate that efferent neural conduction function both centrally and peripherally, and TA muscle function slightly improved immediately after the surgical correction of scoliosis, and further normalization appeared after six months in the long-term follow-up (at p = 0.03). The sEMG recordings indicate that half a year after surgical treatment in IS patients, the TA muscle motor unit recruitment function, as well as the muscle strength evaluated with Lovett’s scale, was comparable to the normal condition. The ENG recording results indicated a gradual reduction in the motor fiber injury symptoms, mainly of the axonal type, in the peroneal nerves. The surgeries also improved the lumbar ventral roots’ neural transmission to a normal functional status. The MEP amplitude parameter values recorded after the surgical scoliosis corrections in T1 indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts; in the long-term T2 observation period, they reached values comparable to those recorded in healthy volunteers, bilaterally. Preoperatively (T0), the results of all the neurophysiological study parameters in the IS patients were asymmetrical at p = 0.036–0.05 and recorded as worse on the concave side, suggesting the lateralization of neurological motor deficits. One week postoperatively (T1), this asymmetry was recorded as gradually reduced, showing almost no difference between the right and left sides six months later (T2). The presented algorithm for the neurophysiological assessments performed in the pre-, intra-, and long-term postoperative periods using the mcsEMG, MEP, and ENG neurophysiological examinations, together with the clinical studies, may help in the comprehensive functional evaluation of the spinal cord tracts and ventral root neural conduction, which allows the detection of the subclinical neurological changes related to scoliosis itself and the consequences of the corrective surgery. Such an evaluation can also be significant in making final decisions regarding IS surgeries and their personalization after attempting conservative treatments with bracing and kinesiotherapy. Neurophysiological studies, as a sensitive biomarker, allowed us to predict and ascertain the final result of IS treatment in the long-term follow-up, which showed the health status of patients as being comparable to that of healthy volunteers.

Evaluation of the patients after the surgical correction of idiopathic scoliosis in long-term follow-up with the clinical neurophysiology methods has not been presented in detail. This study aimed to compare the results of the neurophysiological studies in 45 girls with scoliosis of Lenke 1-3 types performed pre- (T0), postoperatively (T1, one week after surgery), and 6 months after the surgery (T2). Parameters of surface electromyography during the attempt of maximal contraction (mcsEMG) and transcranially evoked motor evoked potentials (MEP) recorded from anterior tibial muscles, as well as the electroneurography (ENG) of peripheral transmission in the peroneal nerve motor fibers were compared. The results indicate that efferent neural conduction function both centrally and peripherally as well as TA muscle function improve immediately after surgical correction of scoliosis (at p=0.05) and further normalization appears after six months in long-term follow-up (at p=0.03). It has been found in sEMG recordings, that the TA muscle motor unit recruitment function after half a year from surgical treatment in IS patients is comparable to the normal condition. ENG recordings results indicated the gradual retreat of the motor fibers injury symptoms mainly of the axonal type in peroneal nerves, the surgeries improved also the lumbar ventral roots’ neural transmission to the functional status considered as normal. MEP amplitude parameters recorded after the surgical scoliosis correction in T1 indicated a slight improvement in the efferent transmission of neural impulses within the fibers of the spinal tracts; in long-lasting T2 observation, they reached values comparable to those recorded in healthy volunteers bilaterally. Preoperatively (T0) the results of all neurophysiological study parameters in IS patients were asymmetrical at p=0.036-0.05 and recorded as worse on the concave side, suggesting the lateralization of neurological motor deficits. One week postoperatively (T1), this asymmetry was recorded as gradually reduced, showing almost no difference between the right and left sides six months later (T2). The presented algorithm of the diagnostic proceeding pre-, early post-, and long-lasting postoperatively using mcsEMG, MEP, and ENG neurophysiological examinations can be significant not only in making the final decision regarding surgical treatment and its personalization but also helps in precise ascertaining its effects as well as in predicting the final result of IS treatment.

The development of modern technologies has made it much easier to regain the ability to walk after losing a lower limb. The variety of prosthetic feet available on the market allows for optimal choice and appropriate adjustment of the foot prosthesis to the trans-tibial amputee patient’s needs. Unfortunately, the best solutions are often not available to everyone due to their high prices. This study compares the gait patterns of patients using the new concept of an affordable dynamic foot with those of other commonly available but much more expensive foot prostheses. The kinematic and spatio-temporal parameters of gait obtained using the motion capture system were analyzed. For a clear picture of changes in bilateral deficits during gait for the pelvis, hip, knee, and ankle joints, the symmetry function was used. The results indicate that the new and cheaper concept of foot prostheses offers a very similar level of gait quality to that provided by more expensive and popular solutions. The authors suggest that the use of symmetry function thresholds of 10% does not work for amputees.