IONM During Hip Arthroscopic Repair Surgeries
January 24, 2018
Introduction:
Arthroscopic hip surgery is routinely performed for treatment of various hip disorders. Leg traction during labral tear repair for hip stabilization can stretch the sciatic nerve. This may cause temporary or permanent sciatic nerve injury. This study illustrates the benefit of utilizing multimodality Intraoperative Neurophysiological Monitoring (IONM) during hip surgical procedures.
Methods:
We performed a retrospective review of four hip neurophysiological monitoring cases at one medical center. The patients consisted of three females and one male with ages ranging from 47 to 58 years (median: 53 years). Three patients had a right side and one patient had a left side hip arthroscopic labral reconstruction surgery performed. Our recording setup included Posterior Tibial Nerve, Peroneal Nerve and Saphenous Nerve somatosensory evoked potentials (SSEP), TCeMEP and EMG from lower extremities bilaterally. Train of four (TOF) was recorded from the Abductor Hallucis muscle as well for monitoring the level of muscle relaxant.
Results:
All four patients exhibited changes in IONM data during the surgical manipulation. The changes in evoked potentials correlated to retraction in two patients, and leg ischemia in one patient. Low mean arterial pressure may have masked changes due to retraction in one patient. All changes returned to values consistent with baseline by closing except in Patient # 1; latency remained significantly increased in the posterior tibial nerve and peroneal nerve SSEPs.
Conclusions:
Multimodality IONM can be beneficial and a protective tool during surgical procedures involving hip and acetabular areas. Early identification of changes in evoked potentials during hip arthroscopy for labral repair can minimize post-operative neurological deficits due to Sciatic nerve injury and leg ischemia.
Kathryn Overzet, MS, CNIM1, Mark Kazewych, MD2,
Faisal R. Jahangiri, MD, CNIM, D.ABNM, F.ASNM1,
1Axis Neuromonitoring LLC, Richardson, TX;
2Baylor Orthopedic and Spine Hospital, Arlington, TX, USA.
