Intraoperative Neurophysiological Monitoring for ACDF
September 23, 2021
Spine and back health are intricately intertwined with our mobility. For example, a "pinched nerve" or radiculopathy is one of the ways we can become immobilized due to a spinal health condition.
Johns Hopkins Medicine identifies three main symptoms of radiculopathy:
- Sharp pain in the back, arms, legs, or shoulders (depending on the area affected)
- Weakness or loss of reflexes in the arms or legs
- Numbness of the skin and "pins and needles" sensations
Mobility problems can be detrimental to a person's quality of life, regularly keeping them from working, traveling, relaxing, and more. We endure these changes in mobility as we age enough without the implications of radiculopathy, stenosis, and spinal cord compression. One 40-year old male patient presented with these conditions in his cervical spine at C5-C7.
His health conditions resulted in excruciating pain radiating from the neck to the right shoulder and down the right arm. As a result, the patient's medical team identified an anterior cervical ACDF, the patient's first spinal surgery. Fortunately, this patient did not have a history of diabetes or hypertension, which can often lead to increased risks of complications.
"Intraoperative monitoring services can significantly reduce postoperative complications. For each surgery, we provide both an on-site technologist and an offsite telemonitoring physician so your surgeon can get instant feedback," said Dr. Faisal R. Jahangiri of Axis Neuromonitoring in Richardson, TX.
These additional resources in the operating room allow surgeons more tools, insight, and information while performing the procedure. For this surgery, the Axis team recommended the use of upper and lower Somatosensory Evoked Potentials (SSEP), upper and lower Motor Evoked Potentials (MEP), upper Electromyography (EMG), Cranial Nerve X, and Train of Four (TOF).
After decompression of the first level, MEPs were absent from the right forearm FCR and FCU muscles and the right hand's APB and ADM muscles. Because the Axis neuromonitoring technician was on-site with neuromonitoring equipment, they immediately informed the surgeon about the motor evoked potentials change. As a result, the surgeon was able to make immediate corrections to avoid any permanent neurological damage. After the decompression of the second level, the right upper limb MEPs returned and remained stable for the rest of the procedure.
Without the Axis team, the decrease of motor evoked potentials would not have been identified. Intraoperative neuromonitoring provided the surgical team with the knowledge and tools to prevent permanent damage to the spinal cord. Damage to the spinal cord at this location and during this surgery could have resulted in the patient suffering postoperative thigh muscle weakness, numbness, severe pain, or paralysis.
Axis Neuromonitoring provides high-quality intraoperative neurophysiological monitoring (IONM). "During spinal, brain, vascular, ENT, and peripheral surgeries, we monitor the integrity of nerves and neurological responses along neural pathways, helping surgeons identify and protect neural structures," said Dr. Jahangiri. For more information about neuromonitoring and how our practices create the best patient outcomes, call 888-344-2947 or visit https://www.axisneuromonitoring.com.
