L4-5 OLIF PSF, Surgical EMG
November 20, 2021
A 67-year-old patient presented with lumbar spinal stenosis, radiculopathy of the lumbar region, and spondylosis. The patient's symptoms included lower back pain radiating into the legs with numbness, tingling, and weakness. Chronic pain, muscle weakness, and other uncomfortable sensations and feelings can have a debilitating effect on someone's mental health. Living with chronic back pain especially takes a certain toll on a person's body that often leaves them desperate for relief. Even still, undergoing multiple surgeries in an attempt to correct spine conditions can exacerbate these feelings.
A history of cervical fusion, lumbar decompression, and hypertension left this patient anxious for long-term relief. As a result, the surgical team opted for an L4-L5 oblique lateral interbody fusion (OLIF), typically reserved for instances where conservative treatments have proven ineffective to resolve his lower back pain and the tingling and numbness in his legs and quality of life are affected. Additionally, the patient was scheduled for a posterior spinal fusion as well. Both of these procedures were prepped for success thanks to support from Axis Neuromonitoring.
Axis supplied the surgical team with an onsite technologist and an offsite telemonitoring physician for personnel support. "Unlike other IONM companies, we exceed surgeons' expectations during the process of neuromonitoring. Our technicians are among the best in the field who are trained to spot hundreds of potential issues," said Dr. Faisal R. Jahangiri of Axis Neuromonitoring of Richardson, TX.
The Neuromonitoring specialists utilized upper and lower Somatosensory Evoked Potentials (SSEP), upper and lower Motor Evoked Potentials (MEP), lower limbs spontaneous Electromyography (sEMG), Triggered Electromyography (tEMG) for testing the pedicle screws, and Train of Four (TOF) using a lateral approach.
A right-side abnormal train EMG was noted twice in the lower leg during the posterior guidewire insertion while the surgeon inserted the guidewire on the left side. Thanks to the partnership with Axis Neuromonitoring and the additional staff support, the neuromonitoring technologist alerted the surgeon immediately. In addition, by having neuromonitoring specialists in the operating room monitoring the nervous tissues during the procedure, the surgeon could commit all of their attention to performing the surgery at hand without monitoring SSEPs, MEPs, EMGs, TEMGs, and TOFs.
Once the action was quickly taken to resolve the abnormal EMG activity, EMG stabilized and remained quiet through closing. As a result, no neurological deficits were noted postoperatively. A perfect procedure was more critical than ever for this patient, who had already undergone surgery to treat his back pain and subsequent leg symptoms. "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. Jahangiri.
Had Axis Neuromonitoring not been present during this procedure, EMG activity may not have been caught in time for the swift action needed to correct it. This potential miss may have resulted in permanent damage to the spinal cord. In other words, the patient would have experienced postoperative thigh muscle weakness, numbness, severe pain, or paralysis.
