SSEP Change During Extreme Lateral Interbody Fusion
By Admin | March 01, 2023
When spinal disorders and the resulting pain are unresponsive to other therapies, an extreme lateral interbody fusion (XLIF) can provide relief to patients by fusing two levels of the spine from the side of the lower back.
Recently, a 77-year-old female patient with a surgical history, including hip surgery, sought help for her debilitating lower back and leg pain. After a thorough diagnosis revealed multiple spinal conditions, including central stenosis, foraminal stenosis, radiculopathy, spondylosis, and spondylolisthesis, the medical team concluded that an XLIF procedure would offer the best chance for alleviating her symptoms and improving her quality of life.
Beginning with a small incision on the patient’s side, an XLIF uses a 1-inch portal retractor to access the damaged vertebral disc. Once the ailing portion of the disc has been removed, a graft or cage is inserted in its place. Then, while the affected vertebrae fuse, the implant maintains and stabilizes the distance between them alleviating the resulting pain.
While this procedure is generally considered to be minimally invasive, a risk always exists for postoperative motor deficits, which in a patient who has a history that includes hip surgery, there is an even higher risk. To ensure the safety and efficacy of the procedure, various monitoring techniques, such as somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), electromyography (EMG), train-of-four (TOF/TO4), and nerve conduction velocity testing, were employed during the surgery.
During the discectomy phase of the procedure, the left saphenous somatosensory evoked potentials showed a decrease, indicating a potential risk to the sensory pathway. The medical team addressed this issue by adjusting the intensity and rep rate for this modality, ultimately leading to the restoration of the left saphenous SSEP values to around the baseline level. Although saphenous somatosensory evoked potentials were discontinued for the posterior procedure, their monitoring played a crucial role in preventing significant motor deficits in the patient.
Somatosensory evoked potentials (SSEPs) play a pivotal role in ensuring the success and safety of complex spinal procedures such as extreme lateral interbody fusion (XLIF). By monitoring SSEPs during the surgery, medical teams can detect and address potential risks to the sensory pathway, ultimately preventing significant motor deficits and enhancing patient outcomes.
Axis Neuromonitoring provides high-quality intraoperative neurophysiological monitoring (IONM). For more information about neuromonitoring and how our practices create the best patient outcomes, call 888-344-2947 or visit https://www.axisneuromonitoring.com.
