Intraoperative Neurophysiological Monitoring (IONM) for Scoliosis and Sciatica
By Admin | May 04, 2021
Sciatica pain can be excruciatingly painful. According to Harvard Medical School, "Sciatica is one of the most common, yet misunderstood, types of pain. As many as 40% of people will get it during their life, and it becomes more frequent as you age." The condition's reach to large swaths of humanity makes it a serious issue. In some cases, sciatica can make walking difficult to impossible.
What causes sciatica? Sciatica is the result of symptomatic degenerative scoliosis and is usually accompanied by:
- A dull ache or stiffness in the mid to lower back
- Shock-like back pains that can radiate down the buttock and into the leg
- A "pins-and-needles" tingling or numbness that can radiate down the buttock and into the leg
- Sharp leg pain that develops while walking but subsides with rest
A 72-year-old patient came in with degenerative scoliosis, lumbar stenosis, and neurogenic claudication, effectively cinching the nerves running through their lumbar region and down into their lower body. These conditions resulted in lower back pain radiating bilaterally into the legs (with more intense pain on the left) and numbness and tingling in the lower extremities. In addition to these symptoms, the patient was also hypertensive.
A lateral lumbar interbody fusion at L1-L5 would be required to treat the patient's condition. Lumbar interbody fusion involves adding a bone graft to the prescribed area to trigger the intended bone tissue to grow together and end motion at that segment of the spine.
All surgeries carry risk, but that especially applies to spinal surgeries. One of the most effective ways to counteract this danger is to integrate neuromonitoring into the procedure. "Axis Neuromonitoring monitors the integrity of nerves and neurological responses along neural pathways, helping surgeons identify and protect neural structures and improve patient outcomes," said Dr. Faisal R. Jahangiri of Axis Neuromonitoring in Richardson, Texas.
In this procedure, the neuromonitoring tests used included upper and lower Somatosensory Evoked Potentials (SSEP), upper and lower Motor Evoked Potentials (MEP), lower Electromyography (EMG), lateral approach nerve conduction velocity, and Train of Four (TOF).
Neuromonitoring allowed the surgical team visibility to critical sensory data during the procedure. For example, following the placement of the L3-L4 interbody cage, the vastus medialis (quadriceps) muscle response was absent. Because of Axis neuromonitoring, the surgeon was informed of the loss of the muscle response, acknowledged the situation, weighed their options, and was able to make a more informed decision on how to proceed. The surgeon elected to continue with the procedure after the response returned and completed the fusion.
As a result of collaboration with Axis Neuromonitoring, the patient did not experience any neurological deficits postoperatively. Had the Axis Neuromonitoring Technologist not been present, the loss of quadricep muscle (vastus medialis) motor response would not have been identified on time, which could have resulted in nerve root or spinal cord damage. The patient could have experienced postoperative muscle weakness, loss of hip flexion, numbness, or severe pain for what could have been the rest of their life.
"Axis Neuromonitoring provides high-quality intraoperative neurophysiological monitoring to surgical staff throughout the Richardson, Texas area. Our "patient first" mentality means that patients can expect a dependable, dedicated team that will serve their needs with integrity, accountability, and respect," said Dr. Faisal.