Positioning Anterior Cervical Upper MEP
November 20, 2021
People carry a lot of stress in their neck, upper back, and shoulders. This is because this body area undergoes significant use, from hunching over a computer screen to manual labor and working with your hands. This amount of use causes additional wear and tear on the body, which adds stress to the body's muscles, bones, and nerves. In addition, underlying structural problems exacerbate these day-to-day events and stressors.
At 69-years-old, a person's body has undergone significant wear throughout their lifetime. Years of work, sports injuries, exercise (and often lack thereof) can add up and contribute to an increased chance of damage as the years go by. This male patient presented with a history of neck pain, bilateral back and shoulder pain, right arm numbness, tingling, and left arm weakness. Not only did he experience numerous back issues, but he also had type II diabetes. Luckily, this patient did not suffer from the usual comorbidities associated with diabetes like hypertension, seizures, or the need for a pacemaker.
After analyzing the patient's condition, the surgical team elected for an anterior cervical discectomy and fusion (ACDF). This procedure involves removing a damaged disc to relieve pressure on the spinal cord or nerve root and alleviate corresponding pain, weakness, numbness, and tingling. To assist with this procedure, the team partnered with Axis Neuromonitoring. "Collaborating with Axis provides the benefit of an onsite technologist and an offsite telemonitoring physician. We monitor neural pathways effectively throughout a procedure and give the surgeon instant, real-time feedback if response time or intensities of the neural signals change," said Dr. Faisal R. Jahangiri of Axis Neuromonitoring of Richardson TX.
The monitoring equipment used during this procedure included Somatosensory Evoked Potentials (SSEP), Motor Evoked Potentials (TCeMEP), Upper limbs Electromyography (EMG), and Train of Four (TOF).
To begin the surgery, the Axis Neuromonitoring Technician reported that the Upper MEPs were both reproducible and reliable at the baseline, establishing a standard for the remainder of the surgery. However, during the decompression, the motor responses from the left deltoid, biceps brachii, and the right biceps decreased in amplitude. As a result, stimulation intensity increased, but the muscle responses declined and became attenuated. Thankfully the Axis Neuromonitoring team was present and communicated the changes to the attending surgeon, who could react quickly and release the tape on the patient's shoulders. After removing the tape, the responses returned to baselines.
At closing, all data remained at baseline with no changes. As a result of the partnership between the surgical staff and the Axis Neuromonitoring team, no neurological deficits were noted postoperatively due to removing the tape pressure from the patient's shoulders and brachial plexus at the right time. Had Neuromonitoring not been utilized during this procedure, the abrupt changes in motor signals may not have been identified in time. Had this been the case, improper positioning, ischemia, stretching, or compression of the nerves might have resulted in a brachial plexus injury. This kind of injury would have meant postoperative muscle weakness, numbness, severe pain, burning sensations, or paralysis.
