Intraoperative Neuromonitoring: Case Report on Muscle Twitching-Induced Injuries

Faranak  Behnaz; Narges  Bazgir; Ako  Faridi; Sogol  Asgari

doi:10.18502/aacc.v11i4.19380

Faranak Behnaz Department of Anesthesiology, School of Medicine, Shohada-e-Tajrish Hospital, Shahid beheshti University of Medical Sciences, Tehran, Iran.
Narges Bazgir Hearing Disorders Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Ako Faridi Department of Anesthesiology, Erfan Hospital, Tehran, Iran.
Sogol Asgari Department of Anesthesiology, Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v11i4.19380

Keywords: Intraoperative; Neuromonitoring; Muscle twitching; Tongue injury

Abstract

During surgical procedures, intraoperative neuromonitoring (IONM) allows for real-time assessment of neural structures like the brain, spinal cord, and peripheral nerves. It enables continuous monitoring and early detection of potential damage during surgery. Adequate neuromonitoring is crucial in anesthesiology to maintain optimal brain function and neurological status during procedures. Muscle twitching during IONM is often associated with electromyography (EMG) or motor-evoked potentials (MEPs) and can indicate nerve activation or irritation. Two cases of patients undergoing posterior spinal fusion procedures experienced complications related to muscle twitching during surgery. In the first case, a 45-year-old male patient experienced damage to his lower lips due to muscle twitching in neuromonitoring. In the second case, a 36-year-old man suffered a tongue injury because a mouth guard shifted during surgery. IONM is a crucial component of modern surgical practices, but the cases presented highlight the potential for muscle twitching to cause patient injuries. Surgical teams must prioritize communication and the implementation of protective measures to safeguard against such occurrences. Future research may provide more comprehensive guidelines to enhance patient safety during IONM.