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Intraoperative Neurophysiological Monitoring (IONM) for Patients With A History of Multiple Spinal Surgeries

March 16, 2021

An aging population is creating new challenges for surgeons around the world. Due to the effects of aging, elderly patients face natural degeneration of the structures that make up their spine, resulting in more spinal surgeries. According to the National Institutes of Health, "Low back pain (LBP) has been estimated to have a lifetime prevalence of 60%–80% among the global population, making it one of the most common health complaints." 

Post Surgical Spine Syndrome, commonly referred to by the clinical misnomer Failed Back Surgery Syndrome or FBSS, is a condition that further increases the number of spinal surgeries patients endure. While not a syndrome at all, Post Surgical Spine Syndrome is a term used to describe the trend of singular spine surgeries not being sufficient to remedy patients' back-related ailments.

A 79-year-old male patient was all too familiar with spinal surgery, having undergone several. This patient history makes him an excellent case study for the investigation of intraoperative neuromonitoring's benefits. Admitted with a history of multiple lumbar spine surgeries, lumbar intervertebral disc degeneration, mechanical low back pain, lumbar fusion, and lumbar radiculopathy, this patient was no stranger to surgery. To further complicate his condition, the patient also suffered from diabetes and neuropathy. 

"We understand that all surgical procedures carry risk. However, we aim to not only reduce that risk but to prevent additional surgeries, impairment, and frivolous litigation," said Dr. Faisal R. Jahangiri of AXIS Neuromonitoring in Richardson, Texas.

The patient's surgical team recommended an L3-S1 decompression and a fusion with a subsequent L2 laminectomy. To properly monitor the procedure, the surgical team partnered with Axis Neuromonitoring to ensure the best possible surgical result. The neuromonitoring tests used during this operation included Somatosensory Evoked Potentials (SSEP), Motor Evoked Potentials (TCeMEP), and Electromyography (EMG). 

"Electrodes are attached to your body in various places depending on the procedure performed. A technologist will use these electrodes to send electrical impulses through your body to monitor nerve pathways," said Dr. Faisal.

Changes noted during the operation were notable decreases in the right ulnar's Somatosensory Evoked Potentials (SSEP). The surgeon was immediately informed and acknowledged the signal reduction. Adjusting the patient's right arm, the surgical team returned the right upper SSEP to their baseline values. In closing, the upper SSEPs remained bilaterally stable. As a result, no neurological deficits were present postoperatively due to the patient's arm repositioning. 


Without the involvement of the Axis Neuromonitoring team, any number of consequences could have resulted. For example, if intraoperative neuromonitoring wasn't present to detect sensory changes or if improper positioning was maintained, the patient could have suffered ischemia, stretching, or compression of the nerves. Axis Neuromonitoring aided in preventing postoperative conditions such as muscle weakness, numbness, severe pain, and burning sensations.

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