Christian Permana, Sp.BS-FTB, FINSS, FICS is a neurosurgeon at RS Mandaya Royal Puri with extensive experience in treating various spinal disorders, including cervical pinched nerves.
Recently, he performed surgery for a C3-C4 cervical pinched nerve using Intraoperative Neuro Monitoring (IOM) technology to improve safety and precision during the procedure. The patient was an elderly man, Mr. Andi from Palembang.
The use of IOM is one of the key advantages at RS Mandaya Royal Puri, as it allows doctors to monitor the patient’s nerve function in real time during surgery. With continuous monitoring, the risk of nerve injury can be minimized, making the procedure significantly safer.
“It’s safer because everything is monitored (with IOM). Previously, we imagined that during surgery we didn’t know what was happening inside. Now it’s clear—if something is wrong or not precise, or if another organ is affected, it can be immediately detected,” said Mr. Andi’s son, who accompanied him at his bedside.
“After the surgery, thankfully, the first thing we noticed was that his hands and feet could move on their own. Previously, even a slight touch would cause pain. Now he can kick his legs, and when asked to raise his hands, before only one side could lift, now both can,” he added with relief and happiness.
Contents
Patient’s Condition Before Surgery
The approximately 70-year-old patient came with severe neck complaints. Examination revealed a pinched nerve at the C3-C4 cervical level.
Unlike previous cases handled by dr. Christian Permana, this compression occurred from two directions simultaneously—both from the front and the back of the cervical spine.
This condition caused weakness in the left arm and leg, resulting in difficulty walking. Limb movement became limited, and muscle strength declined due to significant pressure on the spinal cord.
C3-C4 Surgery with Combined Anterior and Posterior Approaches
To address this complex case, dr. Christian performed surgery using two approaches:
1. Posterior (Back) Approach
An endoscopic technique was used to relieve nerve compression from the back, including removal of compressive tissues such as the ligamentum flavum.
2. Anterior (Front) Approach
After decompressing the nerve from the back, the procedure continued with disc replacement at the C3-C4 level from the front of the neck to eliminate the primary source of nerve compression.
This combined approach aimed to ensure complete nerve decompression so that nerve function could recover optimally.
The Important Role of Intraoperative Neuro Monitoring (IOM)
In every spinal nerve surgery, RS Mandaya Royal Puri utilizes Intraoperative Neuro Monitoring (IOM) technology. This system enables the medical team to continuously monitor the patient’s nerve responses and function during surgery.
IOM works by delivering mild electrical signals to evaluate motor and sensory nerve pathways. If signal changes indicate potential nerve disturbance, the surgeon can immediately adjust the procedure.
With IOM:
- Patient safety is enhanced
- Risk of neurological complications is reduced
- Surgical precision is improved
- The procedure becomes more controlled
This monitoring process is conducted in collaboration with a neurologist who specifically oversees nerve function throughout the operation.
Postoperative Progress
Following surgery, the patient showed noticeable improvement in motor function. The strength in his hands and feet, which had previously weakened, began to recover. Movements that were once limited became better, indicating that nerve compression had been successfully relieved.
These improvements serve as positive indicators that nerve decompression was optimal and that nerve function is gradually recovering.
Profile and Practice Schedule of dr. Christian Permana at Mandaya Royal Puri
Christian Permana, Sp.BS, FTB, FINSS, FICS is a neurosurgeon experienced in treating pinched nerve cases using minimally invasive techniques. He is skilled in various modern procedures, including Percutaneous Laser Disc Decompression (PLDD), Percutaneous Endoscopic Lumbar Discectomy (PELD), Percutaneous Stenoscopic Lumbar Decompression (PSLD), Anterior Cervical Discectomy and Fusion (ACDF), and microdiscectomy.
Minimally invasive techniques aim to reduce trauma to surrounding healthy tissues. As a result, patients generally experience less postoperative pain, lower complication risks, and faster recovery times. This approach enables patients to return to daily activities more comfortably and efficiently.
dr. Christian Permana practices at RS Mandaya Royal Puri on:
- Tuesday: 1:00 PM – 5:00 PM
- Thursday: 1:00 PM – 5:00 PM
- Friday: 1:00 PM – 5:00 PM
- Saturday: 1:00 PM – 5:00 PM
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