Neurophysiology Monitoring in ACDF: Ensuring Optimal Outcomes
By Admin | September 17, 2023
Anterior cervical discectomy and fusion (ACDF) is a surgical procedure designed to alleviate symptoms associated with damaged vertebral discs in the neck. By removing the affected disc and inserting an implant, ACDF aims to relieve pressure on the spinal cord or nerve roots, resulting in reduced pain and weakness. However, like any surgical intervention, ACDF carries risks.
That was the situation our 42-year-old male patient found himself faced with. Presenting with foraminal stenosis, radiculopathy, degenerative disc disease, and spondylosis, the patient was experiencing a multitude of symptoms. These symptoms included left-sided neck pain radiating down his left arm, numbness and tingling in the left triceps and hand, and weakness in his left hand. The patient’s condition called for an anterior cervical discectomy and fusion.
To ensure optimal surgical outcomes for the patient, the surgeon requested the implementation of somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMG) during the ACDF procedure. These monitoring techniques enable real-time assessment of nerve function and integrity, allowing the surgical team access to more data and information during surgery.
During the discectomy phase of the procedure, a notable observation was made. There was a significant decrease in the amplitude of SSEPs originating from the right median nerve and right ulnar nerve. This change in SSEPs indicated a potential compromise in the sensory pathway.
Due to the SSEP changes and their potential as an indicator of possible nerve injury, the surgical team carefully removed the tape that was applied during the procedure, as it might have been causing interference. The team also made additional positional adjustments to ensure optimal nerve conduction. These interventions led to the restoration of the SSEPs to their baseline levels, where they remained for the remainder of the surgery.
Following the successful intervention, the patient was able to move all extremities after the procedure. Without neurophysiology monitoring employed in this case, the changes in SSEP amplitudes may have gone unnoticed. If left unattended, the patient could have experienced sensory deficits in his right arm, including continued numbness or weakness.
Neurophysiology monitoring, including SSEPs, plays a critical role in ACDF surgeries. By providing invaluable insights into nerve function and integrity, neurophysiology monitoring allows surgeons to achieve better patient outcomes.
At Axis Neuromonitoring, we are dedicated to providing high-quality intraoperative neurophysiological monitoring (IONM) to support surgeons and enhance patient safety during complex procedures such as ACDF. For more information about the significance of neurophysiology monitoring and its impact on surgical outcomes, please contact us at 888-344-2947.
