Intraoperative Neuromonitoring
What is Intraoperative Neuromonitoring (IONM)?
Intraoperative Neuromonitoring (IONM), also known as surgical neuromonitoring, is a specialized technique used during surgery to help identify and protect critical neural structures such as nerves, the spinal cord, and the brain. It plays a vital role in minimizing the risk of neurological damage during complex surgical procedures.
IONM is conducted in the operating room by a certified Surgical Neurophysiologist and is monitored in real-time by a remote Neurologist. This collaborative team continuously analyzes the patient’s neural responses and provides the surgical team with immediate feedback, ensuring patient safety and enhancing surgical outcomes. Additionally, IONM can help identify and assess the function of neural pathways during surgery.
SPINE
Cervical/Thoracic/Lumbar/Sacral Decompression and Fusion, Trauma, Spinal Cord Tumor Resection, Scoliosis, Spinal Cord Stimulators, Tethered Cord
BRAIN
Acoustic Neuroma/Brainstem Tumor, Microvascular Decompression, Aneurysm Clipping, Brain Mapping, Facial Hemispasm
ENT
Thyroid/Parathyroidectomy, Neck Dissection, Parotidectomy, Inspire Procedures
Common Modalities (IONM)
- Somatosensory Evoked Potentials (SSEP)
- Transcranial Motor Evoked Potentials (TcMEP)
- Electromyography (EMG)
- Free-Run Electromyography (fEMG)
- Triggered Electromyography (tEMG)
- Direct Nerve Stimulation
- Electroencephalogram (EEG)
Advanced (IONM) Modalities
- Sensorimotor Cortex Localization
- Motor Mapping
- Language Mapping
- Dorsal Column Mapping
- Saphenous SSEP
- Collision Studies
Interpreting Physician & Real-Time Oversight in IONM
Every surgical procedure utilizing Intraoperative Neuromonitoring (IONM) is supported by a licensed neurologist, credentialed at the hospital where services are rendered. This Interpreting Physician (IP) is responsible for interpreting the IONM data in real time. Communication between the IP and the AMS Surgical Neurophysiologist is established through a secure, HIPAA-compliant internet connection from the operating room. The IP and technologist maintain active communication before and throughout the procedure, ensuring immediate dialogue and timely recommendations for medical intervention if any neurological changes are detected.
Why Real-Time Oversight Matters
According to CMS (Centers for Medicare & Medicaid Services) guidelines, real-time data interpretation by a qualified physician is essential for compliance and optimal patient care. If an Interpreting Physician is not involved, the responsibility and liability may fall on the hospital and the surgeon, who would then be considered as overseeing the technologist. Having a dedicated IP ensures that best practices are followed and that patient safety is prioritized throughout the surgical process.
