Intraoperative Neuromonitoring for Pedicle Screw Placement
September 23, 2021
In 2019, police reported 6,756,000 motor vehicles crashed to the National Highway and Safety Association. Of those noted, 2,740,000 were reported as injured as a result of a crash. These statistics leave millions with traumatic injuries, many of which suffer chronic pain for years following an accident. Some of the most common injuries following a car or motor vehicle accident include:
- Traumatic brain injuries (TBI)
- Spinal cord injuries and paralysis (quadriplegia/tetraplegia and paraplegia)
- Back Injuries
- Burns
- Internal injuries
- Fractures and broken bones
One 86 year-old male patient was unfortunate enough to become one of these statistics. After being in a motor vehicle accident, the patient experienced severe back pain due to an L4 fracture. L4 fractures are synonymous with severe back, leg, and arm pain. Someone suffering from this kind of injury might also feel weakness or numbness in these areas if the fracture injures the spinal cord's nerves. The surgical team determined the best course of action for this patient to be a pedicle screw placement at L4.
Axis Neuromonitoring partnered with the patient's surgical team to provide a certified neuromonitoring technologist and additional remote neurologist to oversee the procedure, along with upper and lower Somatosensory Evoked Potentials (SSEP), lower S-EMG, T-EMG NCV, and Train of Four (TOF) tests. "Both of these professionals work together to ensure that neural pathways are monitored effectively throughout a procedure. Two sets of eyes on the neural data help ensure that your surgeon receives real-time feedback if response time or intensities change," said Dr. Faisal R. Jahangiri of Axis Neuromonitoring in Richardson, TX.
After the pedicle screw placement, the team observed spontaneous EMG activity in the right vastus medialis. The team determined the cause to be the screw pressing the L4 nerve root. Once the screw was replaced, the team tested the EMG activity again and received a satisfactory result. The surgeon acknowledged the new measurement and was content to close.
Thanks to the collaboration of Axis Neuromonitoring, no neurological deficits were noted postoperatively. Without the benefit of additional monitoring equipment and personnel, the spontaneous EMG activity would not have been identified on time by the intraoperative neuromonitoring technologist. A late response to this surgical hurdle may have caused permanent nerve root or spinal cord damage. For our example 86 year-old patient, this would have meant postoperative muscle weakness, numbness, and/or severe pain. "Intraoperative monitoring services can significantly reduce postoperative complications. Our clinical guidelines are amongst those of the highest level in the industry. All technologists are members of ASNM and/or ASET and are either board certified or pursuant in their CNIM or R.EP T certification from ABRET," said Dr. Jahangiri.
