What is Intraoperative neurophysiological monitoring (IONM)?How it is help in Neurosurgery and Orthopedic deformity type of Spine Surgery?.

Introduction about IONM

• Intraoperative neurophysiological monitoring (IONM) helps to  assess the integrity of neural structures and consciousness during surgical procedures. It includes both continuous monitoring of neural structure  as well as the localization of  functional neural elements. The goal of IONM is to identify intraoperative neural insults that allow early intervention to eliminate or to significantly minimize irreversible damage to the neurological structure and prevent a postoperative neurological deficit.

Intraoperative neurophysiological monitoring divided in two major parts.

I-Monitoring .

II-Mapping .

• Monitoring prevents from  the permanent damage .

• Mapping prevents from the pre damage .

What are the types of Modalities we use in different cranium and spine surgery.

Motor.

• .Transcranial Electrical Motor Evoked Potential (TCEMEP).

• .Trigger Electromyography (TEMG).

• .Free Run/Spontaneous  Electromyography/ (F/SEMG).

• .Lateral Spread Response (LSR).

• .Direct Wave (D,Wave).

• .Collision Study( C/S).

• .Indirect Wave (I,Wave).

Sensory.

• .Somatosensory Evoked Potential (SSEP).

• .Brainstem Auditory Evoked Potential (BAEP).

• .Visual Evoked Potential (VEP).

Reflex ( To assess the afferent and efferent pathways)

• .Bulbocavernosus Reflex Study ( BCR).

• .Blink Reflex Study. (BRS). ETC.

Signal Recording.

Signal records various part of the body depend on procedures .

Clinical Implications.

• The risk of development of neuro-deficit following neuro-spinal surgery with or without any recognizable adverse event is known. Intraoperative neurophysiological monitoring (IONM) use during neuro-spine surgery, including motor-evoked potentials (MEPs), somatosensory-evoked potentials (SSEPs), and electromyography (EMG), and other modalities  leads to early recognition and management of any signal changes during the procedure, thus predicts a favorable surgical outcome. Loss of IONM signals or any variation from baseline indicates a neural injury and predicts postoperative neuro deficits development.

Standard Practice.

Intraoperative neurophysiological monitoring (IONM) is considered the standard of care during many procedures, including spinal, intracranial, and vascular surgeries, where there is a risk of neurological deficit . Effective communication and close cooperation between multidisciplinary teams, including intraoperative neurophysiological (IONM) team , anesthesiology, and surgery team, is required for high-quality perioperative care to detect and prevent neurologic injuries.

{Note- If scroll down than you will find the sequence of IONM article it may be useful for you.}

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Related to this article.

Is there essential Intraoperative Neurophysiological Monitoring in Deformity spine scoliosis surgery?

https://neurointraoperative.com/wp-admin/post.php?post=1451&action=edit

https://www.sciencedirect.com/science/article/pii/S2467981X22000439

• intraoperative neurophysiological monitoring can help other field of surgery also apart from neuro-spine?.

• Which fibers {sensori-motor} neurophysiology monitors?.

• What is the history of this subject?.

• What exactly we understand from monitoring and mapping?.

• What kind of modality will be used in intramedullary spine tumor?.