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Intra-Operative Neuromonitoring

A medical expert monitors the reading during the spine surgery.
Published by Dr. Umesh Srikantha on April 19, 2020

Intraoperative Neuromonitoring (IONM) is a rapidly-growing field that involves the monitoring of the Central and Peripheral nervous systems of patients while they are undergoing surgical procedures. By using neurophysiologic recordings, we can identify changes caused at the operative site due to surgical insults, and reduce the risk of post-operative deficits.

Introduction of IONM has reduced the risk of debilitating deficits such as muscle weakness, paralysis, hearing loss, and other loss of normal body functions.

IONM is normally performed by technologists supervised by a physiologist, or a neurologist

The image illustrates Intraoperative Neuromonitoring.

What is the purpose of using Intra-operative Neuromonitoring?

  • Reduce the risk of postoperative neurological deficits
  • Identify specific neuronal structures and landmarks that cannot be easily recognized.
  • Assessing the functional status of nervous tissue, including spinal column tracts, eloquent brain regions, and peripheral nerve.
  • Neurophysiologic information helps the surgeon perform a safer and sometimes more thorough procedure.

What are the indications for Intra-operative Neuromonitoring?

  • Highly recommended
    • Deformity correction
    • Severe spinal cord compression
      • Cervical myelopathy
      • Thoracic disc/ OLF
      • DLIF
    • Spinal dysraphism
      • Differentiate functioning and dysplastic neural tissue
  • Routine
    • All cervical and thoracic cases
    • OLIF
    • Lumbar pedicle screw integrity

What modalities are used for Intra-operative monitoring during spine surgeries?

  • MEP (Motor Evoked potential)
  • SSEP (Somatosensory Evoked Potential)
  • EMG (Electromyography)
    • Continuous EMG
    • Spontaneous EMG
    • Trigger EMG
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