Intraoperative Neurophysiological Monitoring (IONM) for Geriatric Patients
October 05, 2020
According to the American Society of Anesthesiologists, 1 in 10 people who have surgery is 65 or older. And while being older can make the need for surgery more likely, it can also lead to a greater risk for complications. In spinal surgery, these risks can increase significantly due to their proximity to the spinal cord. Damage to the spinal cord, especially for older patients, can be detrimental to their quality of life should complications occur during surgery.
For a 67-year-old patient, numbness and weakness in the legs can lead to difficulty walking and make independent living a serious, if not impossible, challenge. The patient's potential risk amplifies when their history includes factors such as hypertension and previous cervical fusion and lumbar decompression surgeries. Cases such as these benefit significantly from measures to detect and combat complications in the operating room. Intraoperative Neurophysiological Monitoring (IONM) provides surgical teams with the necessary resources to provide a patient care level that otherwise would not be possible. IONM uses sensors placed on the patient's body to monitor the body's neural network's functional integrity. Information provided using this technique allows the surgeon to provide a safer and more controlled surgery, which is crucial to maintaining their quality of life post-surgery in the case of geriatric surgeries.
This 67-year-old patient underwent an L4-L5 Oblique Lateral Interbody Fusion (OLIF) and posterior spinal fusion (PLIF) to repair spinal stenosis, radiculopathy, and spondylosis of the lumbar region. Spinal stenosis is characterized by a narrowing of the spaces within your spine. This narrowing can then lead to radiculopathy, which the patient also experienced.
In this particular procedure, abnormal activity was noted on right-side Electromyography (EMG) by the AXIS monitoring technologist twice in the tibialis anterior during the posterior guidewire insertion. The surgeon was inserting a guidewire on the left side. Because the technologist was in the room reading the data, they were able to alert the changes in data to the attending surgeon to make the necessary adjustments that led to the data return to its baseline measure. "In surgery, the presence of a technologist in the operating room ensures a specialist is reading data and reports, and the surgeon can focus on performing the necessary surgery," said Dr. Faisal R. Jahangiri of AXIS Neuromonitoring in Richardson, Texas.
Had the spontaneous EMG not been identified on time by an intraoperative neuromonitoring technologist, it may have resulted in a nerve root damage. In other words, the patient would have likely experienced muscle weakness, numbness, severe pain, or foot drop, a condition in which the patient can no longer raise the front of their foot due to weakness or paralysis. Suffering from foot drop can make it difficult to walk and even more difficult to climb stairs.
The use of intraoperative neurophysiological monitoring in this procedure and ones like it can reduce risk and prevent postoperative neurological deficits by informing the surgeon of potential complications before it's too late.