Intraoperative Neurophysiological Monitoring (IONM) for Patients With Multiple Spinal Conditions
By Admin | August 04, 2021
Chronic back pain, spine disorders, and associated conditions can be seriously debilitating. The spinal column is responsible for a large majority of our posture and balance. When the spine is not operating at peak performance, subsequent conditions are accelerated and exacerbated as strain is put on adjacent muscles, vertebrae, and nerves. Because of this domino effect, patients experiencing conditions like spondylolisthesis, spondylosis, and degenerative disc disease are at a greater risk for increased severity of their condition and additional complications.
One 55-year old male patient presented with C4-C5 spondylolisthesis (slipping of one vertebra onto another), C5-C6/C6-C7 spondylosis (degeneration and inflammation of the spine), and C7-T1 degenerative disc disease (the break down of intervertebral discs between each vertebra). The consequences of these abnormalities included right-hand tingling and atrophy and radiculopathy (pinched nerve) at C8. Radiculopathy at this position is denoted by pain, weakness, numbness, and tingling. With a consistent breakdown of vertebrae starting at C4 through to T1, surgical intervention would be critical to recovery and a return to a better quality of life. This patient had no previous spinal surgeries but did have a history of diabetes and high cholesterol.
Patient history is crucial in determining the estimated success rate of a procedure before bringing the patient into the operating room. Information like the number of spinal surgeries a patient has undergone can drastically affect the prescribed treatment method. For example, if a patient has already undergone two-level spinal fusions, a third is generally out of the question as a third-level spinal fusion can significantly prohibit movement and flexibility to the point of chronic pain. This limitation creates a necessity that fusions be as successful as possible to mitigate the requirement of another. However, a history of conditions such as diabetes and high cholesterol comes with additional risks and challenges for surgical staff as they can negatively contribute to surgery success.
The surgical team determined the best course of action for this patient would be an anterior cervical discectomy and fusion surgical intervention. This procedure involves the removal of damaged disc tissue to relieve pressure and alleviate the related symptoms. For procedures of this nature, providing the best outcomes for patients is essential. To provide such an experience for this patient, Axis Neuromonitoring provided intraoperative neuromonitoring to assess the patient’s nerve response more accurately. “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 surgeons receive real time feedback if response time or intensities change, allowing them to make necessary corrections and maintain integrity of the nerves,” said Dr. Faisal R. Jahangiri of Axis Neuromonitoring in Richardson, TX.
The neuromonitoring tests used during this procedure included:
- Upper and lower Somatosensory Evoked Potentials (SSEP)
- Upper and lower Motor Evoked Potentials (MEP)
- Upper Electromyography (EMG)
- Cranial Nerve X
- Train of Four (TOF)
During the discectomy at C6-C7, the neuromonitoring technician reported bursts in EMG and TOF activity from the left forearm muscles. The activity was also observed for the left biceps during discectomy at C5-C6. The surgical staff and Axis technicians collaborated to pause the procedure to address these bursts in activity, which allowed the patient’s EMG to recover before the team continued.
As a result of the surgical team’s and Axis’ partnership, no neurological deficits were noted postoperatively. “Intraoperative monitoring services can significantly reduce postoperative complications. We understand that all surgical procedures carry risk, but we aim to reduce that risk, prevent additional surgeries, and impairment,” said Dr. Jahangiri.
Without Axis Neuromonitoring, there wouldn’t have been an intraoperative neuromonitoring technologist to detect spontaneous EMG activity on time, resulting in a nerve root or spinal cord damage. As a result, the patient could have suffered postoperative muscle weakness, numbness, severe pain, or any number of other associated symptoms.
For more information about Axis Neuromonitoring, speak with a member of our team by calling 888-344-2947 or visit our contact form here.