Intraoperative Neurophysiological Monitoring (IONM). At the forefront of medical advancements, IONM plays a pivotal role in ensuring the safety and success of various surgeries, especially those involving the nervous system.
Spine surgery:
Spine surgery is increasingly being performed the world over. With advances in technology, surgery of the spine and spinal cord is increasingly becoming safer than it used to be earlier.
Spine and Spinal cord- Vital Organs
However, it is important to remember that the spine is the bony enclosure that surrounds and protects the spinal cord.Millions of nerves and neurons are originating from the spinal cord which is responsible for many actions taking place in our body.It is the second most important organ in the human body next to our brain.It controls many activities in our body like walking and so on.
Effects of the carelessness of spine and spinal cord operation:
During surgery on the spine or direct surgery of the spinal cord, it is likely that the spinal cord and the nerve roots that exit from the spinal cord can get damaged. If this unfortunate event happens, then the patient may be left with the weakness of the arms , legs as well as the inability to control urinary bladder and bowel functions. The chance of such injury happening during spine surgery is more when performing complex spine surgeries such as surgery of the craniovertebral junction, i.e. the junction of the skull and the spine where the brain becomes continuous with the spinal cord. Such unfortunate events can also happen when operating on tumors that afflict the spinal cord or its surroundings.
Intraoperative Neurophysiological Monitoring during complex spine surgery:
Recently, surgeons operating on the spine and spinal cord have started using what is known as Intraoperative Neurophysiological Monitoring. Using this technique, it is possible to continuously monitor the function of the spinal cord during surgery. A neurophysiologist specifically trained to perform intraoperative monitoring will perform the monitoring technique. Using this technique, he/she will be able to warn the surgeon that changes in the electrophysiological activity of the spinal cord that will lead to postoperative problems. Hence, the chance of patient developing fresh problems after surgery will be decreased greatly.
There are several techniques for intraoperative neurophysiological monitoring
Techniques used:
SSEP (somatosensory evoked potentials) which monitor the sensory pathways,
Tc MEP (Transcranial motor evoked potential) where electrodes are placed on the surface of the patient’s skull and the stimulation is used to monitor the motor pathways that are responsible for the movements of the limbs,
Triggered EMG (Electromyography) where individual nerve roots are stimulated to find out their functionality.
Coordinated Teamwork , fruitful result:
The operating team should discuss among themselves the appropriate technique needed for each patient before the surgery. There should be close coordination between the surgeon, the anesthesiologist and the neurophysiologist from the beginning to the end of the surgery. Such coordination will help reduce the chance of an adverse outcome and vastly improve the chances of patient’s successful recovery from Complex Spine Surgery.
Thus Intraoperative Neurophysical Monitoring during complex spine surgery will lead to successful spine and spinal cord surgery by the good team work.
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