Overview for Surgeons

 

Consulting neurophysiological monitoring (IONM) significantly reduces adverse outcomes and iatrogenic physical impairment. Whether for orthopedic surgery involving the spine (for example scoliosis surgery, extra- or intramedullary tumor resection, hardware insertion or removal), the brain (tumor resection, aneurysm clipping), interventional neuroradiology or vascular procedures (carotid endarterectomy, stenting, aortic aneurysm surgery) IONM is of exceptional, and proven benefit in protecting patients from injury.

Prospective, case control as well as retrospective studies published over the past 20 years attest to IONM efficacy, and it is considered valuable in the management of orthopedic and neurosurgical patients by many professional organizations, among them the American Academy of Neurology, American Clinical Neurophysiology Society, Scoliosis Research Society, American Association of Neuromuscular and Electrodiagnostic Medicine.


Because it is a specialized medical practice, the American Medical Association mandates that intraoperative monitoring cannot be performed by unsupervised non-medically trained personnel, and CMS has indicated that the supervising physician should preferably be a neurologist and must not be the anesthesiologist, or surgeon directly involved in the case.


For more than 25 years, IONM has been available in specialized academic settings. Now, through significant technology and communication developments, it is accessible to all hospitals using remote monitoring, helping an increasing number of patients.


Specialist professional expertise is mandatory since: a) monitoring methods are constantly changing due to technology and bandwidth improvements providing the capability to transmit very complex neurophysiological data and b) the increasingly sophisticated array of neurophysiological testing available allows more precise monitoring both require exceptional clinical and technical expertise.


By avoiding/ reducing the incidence of intraoperative complications, length of stay may be shortened when IONM is used.


Malpractice premiums may be reduced with IONM and insurers have designated hospitals as specialist centers, increasing the reimbursement level based in IONM use.

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