Does Intraoperative Neuromonitoring make a difference in Spinal Surgery Procedures for Spinal Stenosis?
By Admin | April 30, 2020
Published: Apr 30, 2020
This may sound like the beginning of a joke, but what do a professional wrestler and a 57-year-old female with a history of bilateral leg, groin and buttock pain with numbness and weakness have in common?
Spinal stenosis, and unfortunately, it's no laughing matter.
Spinal stenosis is a condition that causes an abnormal narrowing of the spinal canal. Over time, this narrowing causes pressure on the spinal cord or nerve roots. Symptoms of spinal stenosis include pain, numbness, or weakness in the arms or legs.
Adam Copeland, also known as WWE's Edge, made his return to the ring after retiring from the sport in 2011 due to the condition.
But after two spinal surgeries to treat his spinal stenosis, Edge was able to return to wrestling this year for the Royal Rumble held in January. He also competed again in March of this year, earning a top prize.
The causes of spinal stenosis include overgrowth of bone, osteoarthritis, bone spurs, herniated discs, thickened ligaments, tumors, and in The Edge's case, spinal injuries caused by repeatedly jumping into the ring, falling off ladders and other spine-jarring situations.
No matter the causes of spinal stenosis, many patients end up with severe pain and often face surgery—which is where the 57-year-old-female patient of AXIS Intraoperative Neuromonitoring comes in.
AXIS provides monitoring services of the nerves, spinal cord, brainstem, and brain during surgical procedures, which helps to reduce the risk of post-procedure complications significantly.
The patient was admitted to the hospital with spinal stenosis with pain in both legs, groin, and buttock pain and muscle weakness in her lower limbs.
The patient was scheduled for an L4-S1 laminectomy procedure to increase the space in the spinal canal and an L4-5 posterior lumbar interbody fusion (PLIF) to help stabilize the treatment area.
During the surgery, the patient was monitored with diagnostic tools to track her nerve activity during the operation. These tools included Somatosensory Evoked Potentials (SSEP) and Electromyography (EMG).
During her L4-L5 lumbar laminectomy portion of the procedure, the AXIS technologist working in the operating room noted abnormal spontaneous EMG activity in the right gastrocnemius, a muscle found in the lower leg, and foot muscles during the decompression portion of the procedure.
Upon noticing the change, the surgeon was immediately notified by the AXIS technologist. The surgeon stopped working in the portion of the spine that controls the nerve root for this portion of the leg and foot.
As a result of IONM, the patient did not suffer any nerve damage or neurological deficits postoperatively that would cause pain or affect mobility.
"Had the change in the patient not been noticed on time and the course of action changed, the patient may have suffered post-surgical complications what would have affected how she lived the rest of her life," said Dr. Faisal R. Jahangiri of AXIS Neuromonitoring in Richardson, Texas.
Keywords: Spinal stenosis, Edge, intraoperative neuromonitoring, surgery