Neuromonitoring and Lumbar tumor resection with stabilization using pedicle screws
December 07, 2020
Benign or malignant, the word tumor elicits fear in even the most tenacious of hearts. Due to its association with cancer, tumors are notoriously known for the specific danger they can entail for anyone unlucky enough to come into their sights. Even benign tumors, while not cancerous, can have life-threatening complications. A tumor on the spinal cord, for example, can lead to serious pain, spinal instability, and even vertebral fractures. They affect neurological function by pushing on the spinal cord or nerve root and can result in permanent disabilities. Spinal tumors can change their lives forever.
A 38-year old male patient presented with this same predicament, a lumbar spinal tumor. Spinal tumors can cause back pain, loss of bowel or bladder function, and affect the way you walk. In order to rid the patient of his ailment, surgical treatment would be necessary. Excising the tumor included a lumbar laminectomy at L1- S1 followed by a tumor resection at L1-S1. Given the level of both the precision necessary to perform such a surgery and the potential implications for complications, the surgical team chose to partner with Axis Neuromonitoring to ensure the success of the procedure and the safety of the patient.
Axis Neuromonitoring provided upper and lower limbs Somatosensory Evoked Potentials (SSEP), upper and lower limbs Motor Evoked Potentials (MEP), lower Electromyography (EMG), H-Reflex, and Train of Four (TOF) to observe the patient’s nerve responses during surgery along with a specialized technician and the remote presence of another surgeon. Due to the presence of an Axis neuromonitoring technician, the operating surgeon was able to focus on performing the surgery at hand while specialized experts monitored the patient signals on the neuromonitoring equipment. “Both of these professionals work together to ensure that neural pathways are monitored effectively throughout a procedure,” said Dr. Faisal R. Jahangiri of AXIS Neuromonitoring in Richardson, Texas.
During the tumor resection, there was global EMG activity detected in the left tibialis anterior, gastrocnemius, adductor hallucis, and anal sphincter. Because an Axis technician was present in the operating room, the surgeon was able to be alerted immediately and adjust accordingly. After the intervention, the concerning EMG activity returned to baseline.
What might have happened without Axis Neuromonitoring? What was at stake? If the spontaneous EMG was not identified on time by the intraoperative neuromonitoring technologist, the patient could have suffered nerve root damage. The consequences of which, being postoperative muscle weakness, numbness, or severe pain in the legs or digestive tract, or reduction in the patient’s ability to walk. “As a result of the quick, efficient feedback made available with Axis Neuromonitoring, no neurological deficits were noted postoperatively,” said Dr. Faisal R. Jahangiri.
