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Intraoperative Neurophysiological Monitoring (IONM) for Patients With Cardiovascular Conditions

By Admin | August 19, 2021

Surgery is always a serious undertaking. All things come with risks, and when a patient is under anesthesia and on the operating table, this is more true than ever. To further complicate these delicate procedures, patient history can significantly impact the success rate and complication risk. One of the ways a patient's history can most impact surgery lies in their cardiovascular health. A patient with hypertension or hyperlipidemia, for example, risks experiencing cardiovascular events, cerebrovascular events, bleeding, and mortality. As stated in his article for Annals of Translational Medicine and later published by the National Institutes of Health, Wilbert S. Aronow states, "One systematic review and meta-analysis of 30 observational studies found that hypertension increased perioperative cardiovascular complications by 35 percent."

A 72-year old male patient presented with lumbar spinal stenosis (narrowing of the spinal canal) and the subsequent compression of spinal nerves (neurogenic claudication). The patient's symptoms included low back pain radiating into his left leg, a burning sensation in both thighs, and occasional numbness, tingling, and weakness in both legs. These nerve conditions were previously treated with an L4-L5 fusion. 

The surgical team needed to perform a lateral interbody fusion at L3-L4 to correct the patient's symptoms. Through collaboration with Axis Neuromonitoring, the surgical team was aided by incorporating a neuromonitoring team to observe the patient's nerve responses during surgery. "We work with top-of-the-line manufacturers and software companies to equip our technologists, and thus your surgeons, with the most advanced neuromonitoring systems available," said Faisal R. Jahangiri, MD, CNIM, D.ABNM, FASNM, FASET of Axis Neuromonitoring in Richardson, TX.

For this procedure, neuromonitoring modalities (tests) included:

  • Upper and lower Somatosensory Evoked Potentials (SSEP)
  • Upper and lower Motor Evoked Potentials (MEP)
  • Lower Electromyography (EMG)
  • Lateral Approach Nerve Conduction Velocity (NCV)
  • Train of Four (TOF)

Of course, all surgery comes with risks, and surgeons attend to various changes in the patient's body throughout every procedure. During surgery on our 72-year old patient, there were sudden abnormal EMG spikes on the neuromonitoring screen showing significant activity in the right vastus medialis muscle during placement of the retractors. Because collaboration with Axis Neuromonitoring grants surgical teams assistance from an Axis Neuromonitoring technician, the activity was able to be reported to the surgeon immediately so he could acknowledge and proceed with the procedure with caution. "Having a technologist in the operating room allows the surgeon to focus all of his attention on the surgery and not reading data and reports," said Dr. Jahangiri.

In this case, the surgeon stated that he intended to expedite the L3-L4 discectomy and cage placement. After approximately four minutes, the abnormal EMG activity subsided and remained quiet until closing. In addition, the surgeon stimulated lateral navigation up to 20mA and obtained confirmatory compound muscle action potential (CMAP) to ensure stimulation was effective, and the neural tissue was not in his way.

As a result of the utilization of neuromonitoring technology, there were no neurological deficits noted postoperatively. However, had neuromonitoring not been used and if the abnormal spontaneous EMG was not identified on time by an intraoperative neuromonitoring technologist, it might have resulted in a nerve root or spinal cord damage. This kind of perioperative result likely would have left the patient with postoperative muscle weakness, numbness, severe pain, or a range of other complications in addition to the complication risks he already faced due to his age, hypertension, and cholesterol.

For more information about neuromonitoring and how our practices create the best patient outcomes, call 888-344-2947 or visit

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