The rehabilitation algorithm for patients after removal of cervical intramedullar tumors

Objective: to estimate the effectiveness of rehabilitation in early postoperative period and to reveal the predictors for favorable outcome using integral assessment at patients underwent surgical removal of cervical intramedullar tumors (IMT). Material and methods: We examined and operated 20 patients suffered from cervical IMT with the following rehabilitation course. The integral examination included the neurological assessment, cervical MRI with contrast before and in 6 months after operation, somatosensory evoked potentials (SSEP) as well as transcranial magnetic stimulation (TMS) before operation, after surgical treatment and after rehabilitation course. All operations were conducted under neurophysiological monitoring. All patients were divided into 2 groups to reveal the predictors of favorable outcome: 14 patients with improving of functional status, 6 patients - with no changes or worsening of functional status. The rehabilitation course was prescribed individually taking into account the degree of neurological deficit and estimation by McCormick (MC) functional scale. Results. The differentiated rehabilitation algorithm which effectiveness is based on estimation of neurophysiological measurements was developed. The neurophysiological predictors of favorable clinical outcome based data of neurophysiological monitoring are the follows: the presence of М - answer at the end of operation, the improvement of latency criteria of N20 cortical response according to the data of SSEP which correlates with the improvement of deep sensibility, while the decrease of threshold of evoked motor response according to TMS data reflects the regress of movement deficit. Conclusion. The favorable surgical outcome was observed at patients with functional status I-III according to MC functional scale (mild and moderate neurological deficit). The rehabilitation in early postoperative period leads to maximally rapid adaptation of patients as well as to maximal improvement of motor and sensitive functions to the moment of patients’ discharge.

интрамедуллярная опухоль, интраоперационный нейрофизиологический мониторинг, соматосенсорные вызванные потенциалы, транскраниальная магнитная стимуляция, реабилитация, intramedullar tumor, intraoperating neurophysiological monitoring, somatosensory evoked potentials, transcranial magnetic stimulation, rehabilitation

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