IONM for LLIF, Laminectomy, and Removal of Hardware
September 23, 2021
Spine disorders are like chains of dominoes. One vertebra dysfunction can easily affect the next. Each bone depends on the next for support and structure as each works together in harmony to produce the function and movement we rely on to live comfortably. As these diagnoses pile up, people can quickly go from one minor issue into complex problems that take dynamic solutions to treat.
The nature of spinal pathology makes understanding patient history essential. Previous treatments, past surgeries, comorbidities, and lifestyles can all impact the next step for patients. For example, one 46-year old female patient presented with multiple existing conditions, including:
- Spondylolisthesis
- Lumbar spondylosis
- Spinal stenosis
- Intervertebral disc displacement
- Lumbosacral region
- Radiculopathy
- Pseudarthrosis after fusion
- Pain due to internal orthopedic prosthetic devices
- Chronic pain syndrome
This patient had also undergone a previous anterior lateral interbody fusion and a posterior spinal fusion at L5-S1. In addition to multiple spine-specific conditions, she also had a history of diabetes and hypertension. As a result of her conditions, the patient experienced low back pain, pain, numbness, and tingling in her right leg, and pain in her left leg.
For complex patients like the one described, treatment plans have to be carefully considered and flawlessly executed. The medical team in this scenario prescribed an extreme lumbar interbody fusion at L4-L5, a laminectomy at L4-L5, and removal of hardware L5-S1.
All spinal surgeries are delicate procedures. The proximity to the spinal cord makes anything short of flawless execution of a course a non-option. To support the needs of the multiple procedures and the best chance for surgical success, Axis Neuromonitoring provided:
- Upper and lower Somatosensory Evoked Potentials (SSEP)
- Upper and lower Motor Evoked Potentials (MEP)
- Lower Electromyography (EMG)
- Triggered Electromyography Nerve Conduction Velocity (T-EMG NCV)
- Train of Four (TOF)
“For each surgery, we provide both an onsite technologist and an offsite telemonitoring physician so your surgeon can get instant feedback. This allows our team to deliver high-quality neuromonitoring, cutting-edge technology and techniques, a caring and professional staff, risk management advantages, and countless other advantages,” said Dr. Faisal Jahangiri of Richardson, TX.
Throughout the lateral portion of the procedure, bilateral saphenous nerve sensory evoked potentials registered a low amplitude, despite efforts to troubleshoot the issue. However, the performing surgical team was aware of these issues due to collaboration with the Axis Neuromonitoring team. As a result, it could react accordingly to provide the patient with the most effective and safest outcome. “We monitor neural pathways effectively throughout a procedure and give the surgeon instant, real-time feedback if response time or intensities change, looking for the earliest signs of hundreds of potentially avoidable complications,” said Dr. Jahangiri.
Without that necessary knowledge, many things could have happened while the surgeon attempted to attend to all issues simultaneously. Thankfully, no neurological deficits were noted postoperatively.
What could have been the possible consequences without Axis Neuromonitoring? Suppose the decrease of sensory evoked potentials (SSEP) and EMG responses were not identified by intraoperative neuromonitoring. In that case, it might have resulted in anything from permanent damage to the spinal cord to the patient’s nerve roots. This would have meant the patient experiencing post-operative thigh muscle weakness, numbness, severe pain, or paralysis.
