Our Summary

This research paper is about a study that examined the use of intraoperative neuromonitoring (IONM) during specific types of spinal surgery. IONM is a technique used during surgery to monitor the functional integrity of certain neural structures to reduce the risk of damage. The two types of surgery discussed are lateral lumbar interbody fusion (LLIF) and oblique lateral interbody fusion (OLIF), which are procedures to treat conditions such as disc degeneration or spinal instability.

The researchers looked at various studies to compare the neurological complications seen in surgeries with IONM to those without. They discovered that complication rates for LLIF were high, whether IONM was used or not. Similarly, the use of IONM didn’t show significant benefits in OLIF surgeries either.

In simple terms, the researchers found that using IONM didn’t necessarily make these types of spinal surgeries safer or lead to better outcomes for patients. They suggest that more studies are needed to understand the benefits and limitations of using IONM during these procedures.

FAQs

  1. What is intraoperative neuromonitoring (IONM) and why is it used in spinal surgery?
  2. What were the findings of the study on the use of IONM in lateral lumbar interbody fusion (LLIF) and oblique lateral interbody fusion (OLIF) surgeries?
  3. Does the use of IONM guarantee safer surgeries and better patient outcomes according to the study?

Doctor’s Tip

Therefore, a doctor might tell a patient considering lumbar fusion surgery that while intraoperative neuromonitoring can be a helpful tool in some cases, it may not always significantly impact the outcome of their specific procedure. They may advise the patient to focus on other factors such as proper pre-operative preparation, post-operative care, and rehabilitation to ensure the best possible results. It’s important for patients to have a thorough discussion with their doctor about all aspects of their surgery and recovery to make informed decisions.

Suitable For

In general, lumbar fusion surgery is typically recommended for patients who have not had success with conservative treatments such as physical therapy, medication, or injections, and who have conditions such as degenerative disc disease, spinal stenosis, spondylolisthesis, or spinal instability. Additionally, patients who have tried other surgical interventions such as discectomy or laminectomy without success may also be recommended for lumbar fusion.

It is important for patients to undergo a thorough evaluation by a spine specialist to determine if lumbar fusion is the best treatment option for their specific condition. Factors such as the location and severity of the spinal pathology, the patient’s overall health and activity level, and the presence of any other medical conditions will all play a role in determining whether lumbar fusion is appropriate.

Ultimately, the decision to undergo lumbar fusion should be made in consultation with a spine specialist who can provide personalized recommendations based on the individual patient’s unique circumstances.

Timeline

Before lumbar fusion:

  1. Patient experiences chronic back pain, leg pain, and/or numbness due to conditions such as disc degeneration or spinal instability.
  2. Patient undergoes diagnostic tests such as X-rays, MRI, or CT scans to determine the extent of the spinal issue.
  3. Patient may undergo conservative treatments such as physical therapy, medications, or injections to manage symptoms before considering surgery.
  4. Patient consults with a spine surgeon to discuss the possibility of lumbar fusion surgery as a treatment option.

After lumbar fusion:

  1. Patient undergoes pre-operative evaluations and tests to ensure they are healthy enough for surgery.
  2. Patient undergoes lumbar fusion surgery, which involves removing damaged disc material and fusing two or more vertebrae together to stabilize the spine.
  3. Patient stays in the hospital for a few days post-surgery for monitoring and pain management.
  4. Patient begins physical therapy and rehabilitation to regain strength and mobility in the spine.
  5. Patient continues follow-up appointments with the surgeon to monitor healing and address any issues or concerns.
  6. Patient gradually resumes normal activities and may experience improved back pain and function over time.

What to Ask Your Doctor

  1. How will the use of intraoperative neuromonitoring (IONM) during my lumbar fusion surgery benefit me?

  2. Are there any specific risks or complications associated with the use of IONM in lumbar fusion surgery?

  3. What is the success rate of using IONM in preventing nerve damage during lumbar fusion surgery?

  4. How experienced is the surgical team in using IONM during lumbar fusion procedures?

  5. Are there any alternative techniques or technologies that could be used instead of IONM for my lumbar fusion surgery?

  6. Will I need any additional monitoring or follow-up care if I undergo lumbar fusion surgery with IONM?

  7. How will the use of IONM impact the overall length of my surgery and recovery time?

  8. Can you provide me with any additional information or resources about the use of IONM in lumbar fusion surgery?

  9. What are the potential costs associated with using IONM during my lumbar fusion surgery?

  10. Are there any specific factors in my case that make the use of IONM particularly beneficial or necessary for my lumbar fusion surgery?

Reference

Authors: Nie JW, Hartman TJ, Zheng E, MacGregor KR, Oyetayo OO, Singh K. Journal: World Neurosurg. 2022 Dec;168:268-277.e1. doi: 10.1016/j.wneu.2022.10.031. Epub 2022 Oct 13. PMID: 36243359