In the dynamic area of surgical advancements, Intraoperative Neuromonitoring (IONM) is an emerging technique, that ensures patient safety and revolutionizing surgical outcomes.
At the forefront of this evolving field is the remarkable Dr Nimesha Cheruku, an accomplished alumna of Sri Ramachandra Medical College and Research Institute, and The University of Texas at Dallas. Her journey reflects unwavering dedication and relentless pursuit of knowledge, which has shaped her into a leading person in the domain of IONM.
With over 12 years of experience, Dr Cheruku has not only embraced the profound intricacies of IONM but has also been a passionate advocate for extending its reach. She has shared her wealth of knowledge through various speaker presentations, with a notable one titled "Introduction to Intraoperative Neuromonitoring in Spine Surgery" which garnered immense interest at the International Conference on Neuroscience and Neurology in Dubai.
She defines IONM as a comprehensive study conducted during surgery, monitoring the patient's nervous system through electrodes and electro-physiological recordings. This technique allows for early intervention by identifying neural insults intraoperatively, minimizing or eliminating irreversible damage to the neurological structure. The goal is to prevent postoperative neurologic deficits, including paralysis and loss of function, by identifying insults to the nervous system in real time and enabling immediate corrective actions.
The field of IONM has witnessed substantial advancements over the past two decades, thanks to the dedication of professionals like Dr. Cheruku. Today, IONM serves not only to predict but also to prevent injuries to the nervous system during high-risk neurosurgical procedures. Dr. Cheruku's tireless efforts in spreading awareness about IONM have underlined its significance for both patients and surgeons. Her expertise emphasizes that utilizing a multimodality approach during surgery aids in the early recognition of neurological insults and contributes to favorable surgical outcomes.
One of the prominent areas where Dr. Cheruku's expertise shines is in the realm of Lateral Lumbar Interbody Fusion (LLIF), a minimally invasive approach that offers shorter hospital stays and minimal recovery time. The most common postoperative complications for these procedures are thigh weakness, loss of sensation in the legs, and even paralysis.
To ensure the utmost protection during this procedure, Dr Cheruku advocates for a multi-modality approach, incorporating Somatosensory Evoked Potentials (SSEP)- monitor the electrical potentials recorded from the somatosensory cortex in response to stimulation of a peripheral nerve, Motor Evoked Potentials (MEP)- monitor the descending motor pathways from the motor cortex to the peripheral muscles, EMG (electromyography)- real-time recording of selective nerve root function specific to a muscle, Spontaneous EMG(spEMG)- muscle activity without stimulation, and Triggered EMG- muscle activity with stimulation.
EMG and triggered EMG help in identifying a safe pathway to the disc space. Per Dr Cheruku, though Free run or Spontaneous Electromyography (spEMG) and triggered EMG are commonly used during these procedures, the IONM protocol must be expanded to include Somatosensory evoked potentials (SSEP) from Saphenous nerve on the surgical side, Peroneal nerve SSEP on the non-surgical side in addition to Ulnar and Posterior Tibial Nerve SSEP, Motor Evoked Potentials (MEP) from at least two muscles of the quadriceps and adductors in addition to the other lower lumbar muscles.
This aids in protecting the nerves at risk from patient positioning and steps of the procedure, helping to prevent debilitating postoperative complications. She has shared her knowledge about the neuromonitoring protocol for the LLIF procedure at the 63rd ASET Annual Conference in KY, USA, and at the Global Congress on Spine and Spinal Disorders in UAE.
Furthermore, her contributions extend to Spinal Cord Stimulator (SCS) implant procedures. Dr Cheruku's emphasis on midline placement of SCS leads, guided by IONM using SSEPs, MEPs, and EMG, has proven crucial in identifying and preventing permanent neurological damage. This also highlighted the importance of identifying the physiological midline as opposed to the anatomical midline to identify the specific location of pain and to provide adequate pain management to the patients.
Though SSEPs and EMG have been shown to be significant in these procedures over the years, Dr. Cheruku has shown that MEPs also play a significant role.
Through her expertise and innovative approaches, she has significantly enhanced the accuracy and reliability of neuromonitoring for these procedures.
Beyond her technical prowess, Dr Nimesha Cheruku stands as a staunch advocate for patient safety within the neuromonitoring domain. Her dedication to research and numerous publications in the field have directly influenced patient care, elevating surgical outcomes and enhancing patient safety. Driven by a profound passion for improving surgical outcomes and patient well-being, Dr Cheruku exemplifies excellence in patient care.
Dr Nimesha Cheruku's relentless commitment and pioneering work in the field of Intraoperative Neuromonitoring have elevated surgical practices, ensuring safer procedures and improved patient experiences. Her contributions continue to inspire and educate aspiring healthcare professionals, leaving a noteworthy impression on the ever-evolving landscape of IONM.
