Intraoperative neurophysiological monitoring, also known as neural monitoring, is a simple, minimally invasive and cost-effective tool designed to detect, treat, and prevent potential damage to the nervous system during high-risk medical procedures such as brain, nerve, and spine surgery.
It goes without saying that early detection of potential complications is crucial for patient safety. Therefore, any tool or technique that can prevent or reduce the rate of intraoperative injuries holds tremendous appeal for patients and surgeons alike.
Real time monitoring assists surgeons and anesthesiologists with assessing neural structures, including the neuromuscular junction, peripheral nerve, spinal cord, brainstem, and cerebral cortex. Conducted by an on-site technician and remote interpreting physician, IONM can make any spinal surgery safer and prevent neurological deficits and/or morbidity.
Why is IOM important?
Oftentimes, spinal surgery involves the following procedures:
- Decompression of the spinal nerve roots and/or the spinal cord
- The use of instrumentation (i.e. plates, screws, rods, cages, etc.)
- Deformity Correction (Scoliosis, Kyphosis, spondylolisthesis)
Possible complications may include damage to the spinal cord and nerve roots. As a result, the patient can develop radiculopathy (spinal nerve root injury) or myelopathy (spinal cord injury).
Neuromonitoring has proven to reduce the occurrence of neurological damages during surgery from 4 percent down to .05 percent. Simply put, it ensures patient safety and reduces the physicians' liability while preventing medical errors and bringing down skyrocketing health care costs.
How does it work?
When a patient undergoes spinal surgery, a monitoring technician places wire electrodes on his/her limbs. Electrodes are also placed on the surface of the skull, over the area of the brain that receives the impulse from the limb. A technician uses sophisticated equipment to monitor the electrical activity along the peripheral nerves, spinal cord and in the brain. This activity is being recorded as wave form and used throughout the whole procedure. Any significant change in the wave forms prompts the surgeon that there might be potential damage to the neuromuscular system. That's when the surgical team can take immediate action, averting irreversible injury or post-operative complications.
The better option?
In addition, IONM serves as a better and more reliable alternative to the neurological evaluation when a patient is under anesthesia and not capable of undergoing face-to-face examination. In fact, it may be dangerous to wake up patients suffering from serious conditions. Some individuals may negatively respond to the wake-up test, due to age or mental status. Besides, it can lengthen the time of surgery and does not properly evaluate nerve function.