Intraoperative Neurophysiological Monitoring (IONM) for Patients With Mental Health Conditions
March 16, 2021
Hopelessness can be crippling. Having to endure debilitating physical and emotional conditions only fuels hopelessness further and worsens patients' emotional states. Chronic pain, mental health woes, and disease can strip patients of their will to get better and be an obstacle for seeking help and treatment.
Axis Neuromonitoring provides neuromonitoring services with a patient-first mentality to patients and surgeons throughout the state of Texas. One recent 33-year-old patient benefitted from this approach as much as anyone. This patient presented with lumbar spinal stenosis with neurogenic claudication and mechanical complications from implanted orthopedic devices. In addition to these conditions, the patient was also suffering from hip and back pain.
What makes the subject of hopelessness so relevant to this patient's case is their patient history. This patient's list of comorbidities includes trigeminal neuralgia, depression, anxiety, PTSD, esophageal reflux, insomnia, migraine headaches, snoring, pneumonia, bowel disorders, acid reflux, urinary incontinence, obesity, Cushing's disease, and hypertension. A list of preexisting conditions like this one are not only essential details to discuss with the surgical team before the operation, but they can also be a difficult hurdle to overcome in choosing treatment over inaction. This patient's story is one of triumph, they chose treatment, and thanks to the surgical team's partnership with Axis Neuromonitoring, the patient enjoyed best-case results.
To treat the patient's lumbar spinal stenosis, the surgical team performed a posterior lumbar fusion at L2-Iliac and Transforaminal Lumbar Interbody Fusion (TLIF) at the level of L3-S1. For this particular operation, upper and lower Somatosensory Evoked Potentials (SSEP), lower Electromyography (EMG), Electroencephalography (EEG), and Train of Four (TOF) were used to monitor the patient's neural pathways and test their responses to electrical stimulation.
"Electrodes are attached to your body in various places depending on the procedure being performed. A technologist will use these electrodes to send electrical impulses through your body to monitor nerve pathways. The speed and intensity of the signals are constantly evaluated to established standards," said Dr. Faisal R. Jahangiri of AXIS Neuromonitoring in Richardson, Texas.
During surgery, there was the transient loss of bilateral posterior tibial nerves and peroneal nerves SSEP. Because of an Axis Neuromonitoring technician's presence, the surgeon was alerted right away of a possible low Mean Arterial Pressure (MAP). The operating surgeon acknowledged these readings, and after intervening, the patient's blood pressure was increased to baseline, and the bilateral posterior tibial nerve and left peroneal nerve returned to baseline. As a result of the efforts of the Axis team, no neurological deficits were present postoperatively.
The possible consequences of performing this surgery without neuromonitoring are poor. If sensory changes were not identified by intraoperative neuromonitoring, the patient's low blood pressure would have resulted in spinal cord ischemia. Spinal cord ischemia could have caused the patient postoperative muscle weakness, numbness, severe pain, burning sensations, or possibly even paralysis.