Intraoperative Neuromonitoring

What is Intraoperative Neuromonitoring?

Intraoperative Neuromonitoring (IONM), or Surgical Neuromonitoring,  assists surgeons in locating and protecting nerves, the spinal cord, and the brain during surgical procedures. It has been clinically proven to reduce the patient’s risk of  damage to the nervous system. Intraoperative neuromonitoring can also be used to locate and test the function of neural structures.

IONM is performed by a certified Surgical Neurophysiologist in the operating room  and is overseen remotely in real-time by a Neurologist. Together, they evaluate and interpret data and communicate to the surgical team information needed to safeguard patient safety and ensure positive surgical outcomes.

Frequently Monitored Surgeries


Aneurysm Clipping
Brainstem Tumor
Tumor Excision
Arteriovenous Malformation
Epilepsy Surgery


Neck Dissection
Cochlear Implant
Carotid Endarterectomy


Spinal Cord Tumor Resection
Extreme Lateral Interbody Fusion
Lateral Lumbar Interbody Fusion
Oblique Lumbar Interbody Fusion
Posterior Cervical Decompression and Fusion
Posterior Lumbar Decompression and Fusion
Posterior Lumbar Interbody Fusion
Posterior Spinal Fusion
Removal/Revision of Hardware
Spinal Cord Stimulator Placement
Transforaminal Lumbar Interbody Fusion
Direct Lateral Interbody Fusion
Anterior Cervical Fusion/Decompression
Lumbar Fusion/Decompression
Thoracic Fusion/Decompression
Cervical Fusion/Decompression

Common IONM Modalities

  • Somatosensory Evoked Potentials (SSEP)
  • Trans-Cranial Motor Evoked Potentials (TcMEP)
  • Electromyography (EMG)
    • Free Run Electromyography (fEMG)
    • Triggered Electromyography (tEMG)
  • Direct Nerve Stimulation
  • Electroencephalogram (EEG)

Advanced Modalities

  • Sensorimotor Cortex Localization
  • Motor Mapping
  • Language Mapping
  • Dorsal Column mapping
  • Saphenous SSEP
  • Collision Studies

Interpreting Physician

Every surgery will be supported by a licensed neurologist, credentialed in the hospital where services are provided, who will serve to interpret the real-time data. This will be achieved through a secure, HIPAA-compliant internet connection established by the AMS technologist in the OR. The Interpreting Physician (IP) and technologist will be in communication before surgery begins and continually during the case. This allows for dialogue and alerts with recommendations for medical intervention if changes in test results should occur.

Oversight Is Best Practice

CMS guidelines require that data be interpreted by a physician real-time. If there is not an Interpreting Physician, the hospital and surgeon may become liable for not providing standard of care. The surgeon becomes liable for oversight of the technologist.