The incidence of Positioning-Related Intraoperative Neurophysiological Monitoring (IONM) Changes: A Review of 5894 Surgeries
January 02, 2019
Kathryn Overzet1, Chen Wang1,2 and Faisal Riaz Jahangiri1*
1 Axis Neuromonitoring LLC, Richardson, TX, USA2 Graduate Student, Department of Applied Cognition and Neuroscience, University of Texas, Richardson, TX, USA
Citation: Faisal Riaz Jahangiri., et al. “The incidence of Positioning-Related Intraoperative Neurophysiological Monitoring (IONM) Changes: A Review of 5894 Surgeries”. EC Neurology 11.1 (2019): 46-54.
*Corresponding Author: Faisal Riaz Jahangiri, Axis Neuromonitoring LLC, Richardson, TX, USA.
Received: November 22, 2018; Published: December 27, 2018
Abstract
Introduction: Patient positioning during various surgeries may cause stretching, compression, or ischemia of the peripheral nerves. Upper extremity nerves are more at risk, resulting in postoperative neuropathy. Somatosensory Evoked Potentials (SSEPs) and Transcranial Electrical Motor Evoked Potentials (TCeMEPs) can be beneficial in identifying positioning issues. Repositioning the limb can prevent nerve damage from occurring.
Methods: We retrospectively reviewed 5894 surgeries performed with neuromonitoring from 2016 through 2018 (52% female, 48% male). We utilized a multimodality approach including two or more of the following: SSEPs, TCeMEPs, and Electromyography (EMG).
Conclusions: Multimodality IONM is a protective tool against neuropathy and positioning complications during various surgical procedures. Early identification of changes in signals can detect positioning issues. We highly recommend monitoring upper SSEPs for lumbar surgery due to the correlated incidence rate. The use of IONM to detect changes can minimize post-operative neurological deficit by repositioning. Results: IONM data changes related to positioning were identified in 209 patients (female: 78, male: 131) with ages ranging from 19 to 86 years (median: 59 years). The incidence of positioning changes was 3.5% for all procedures. The signals returned to baseline with repositioning in 78% of the surgeries. Positioning changes occurred in 27.3% of hip, 5.1% of lumbar, 2.5% of thoracic, 2.2% of craniotomy, and 1.5% of cervical surgeries. The highest incidence of change was observed in upper SSEPs (86.7%), followed by lower SSEPs (5.7%), upper TCeMEPs (3.8%), lower TCeMEPs (1.9%), spontaneous EMG (1.4%), and upper TCeMEP and SSEP (0.5%) data. We observed that 82.3% of the changes identified were in upper SSEPs during lumbar surgery.
Keywords: Positioning; Brachial Plexopathy; Ulnar Nerve Injury; Neuropathy; Intraoperative Neurophysiological Monitoring
