Intraoperative Neurophysiological Monitoring (IONM) for Patients With Preexisting Conditions
March 16, 2021
Spinal surgeries are synonymous with a long list of potential complications. If the surgery doesn't go according to plan, it can mean severe postoperative consequences for patients. Due to the spinal cord's proximity to the spinal column, even slight adjustments in patient positioning during surgery can result in muscle weakness or numbness. So what can be done when surgery needs to be performed, but the risk of doing so is mounting?
More and more surgeons and patients alike are seeking the incorporation of intraoperative neuromonitoring for their surgeries. Intraoperative neuromonitoring grants surgical teams additional resources to ensure a safe, best-case scenario surgery for each patient. These resources include an onsite Neuromonitoring Technician, an offsite neurologist specialized in neuromonitoring, and a plethora of neuromonitoring equipment.
"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. Faisal R. Jahangiri of AXIS Neuromonitoring in Richardson, Texas.
All things benefit from more information. In Texas, Axis Neuromonitoring provides surgeons with analytical sensory data to inform their decision-making processes while delivering consistent and reliable feedback.
"There is an entire team of dedicated people working behind the scenes to give our patients the optimum care they deserve," said Dr. Faisal.
The utilization of intraoperative neuromonitoring streamlines spinal surgeries and allows surgical teams the opportunity to provide optimal outcomes for their patients. For one 69-year-old male patient, a series of painful symptoms led him to the operating table. Neck pain, bilateral back and shoulder pain, right arm numbness, tingling, and left arm weakness put this patient at an increased risk for complications from the surgery he needed to remedy his condition. Type II diabetes puts this patient at an even greater risk for further complications.
An anterior cervical fusion was necessary to alleviate the patient's chronic back pain. The motivation for performing a cervical fusion is to fuse the necessary vertebrae so that motion no longer results in pain. Because of the patient's neck pain and bilateral pain across their back and shoulders, the team determined that fusion of the cervical vertebrae would best resolve this ailment.
The neuromonitoring team determined that the following neuromonitoring tests were necessary to perform this surgery successfully: Somatosensory Evoked Potentials (SSEP), Motor Evoked Potentials (TCeMEP), Upper Electromyography (EMG), and Train of Four (TOF). As the surgery began, the upper motor evoked potentials registered at the required baseline readings and reproducible and reliable. During the fusion's decompression stage, the motor responses from the left deltoid, biceps brachii, and the right biceps muscles decreased in amplitude. Although the stimulation intensity was increased, the muscle responses continued to decline and became attenuated. The neuromonitoring technician immediately alerted the surgeon, and the nurse released the tape on the patient's shoulders. After the shoulder tape was removed, the patient's nerve responses returned to baseline. At closing, all data remained as baselines with no changes. The surgeon was informed and acknowledged.
The events that transpired during this surgery and the resulting solution to the reading decreases further demonstrate the fragility of spinal surgeries. Something as frivolous as pressure from shoulder tape had the potential to disrupt the nerve responses in the patient's shoulders and brachial plexus, which could have had dangerous consequences.
What may have been the possible consequences of this surgery without Axis Intraoperative Neuromonitoring? Had the motor evoked potential changes not been identified by the neuromonitoring technician, it could have resulted in postoperative neurological deficits. Any combination of these events can cause brachial plexus injury meaning the patient would have suffered postoperative muscle weakness, numbness, severe pain, burning sensations, or possibly paralysis.