CHIEF MEDICAL OFFICER

The Value of IONM
As Chief Medical Officer, you will most likely find that the opinions of your surgeons vary regarding intraoperative neuromonitoring (IONM). Those surgeons who embrace IONM are educated in its application and have probably observed or worked with a well-trained neuromonitoring team practicing complex, multimodality monitoring. This type of surgical monitoring applies all of the many diagnostic tools available. Knowing when to implement the appropriate modality at the appropriate time separates marginal monitoring groups from the highest quality of neuromonitoring conducted by well-trained neurotechnologists (NTs).

IONM has been studied and well-documented for the past 30 years. There is substantial literature on the merits of its use. For example, reports show that the incidence of neurological complications associated with placement of pedicle screws runs as high as 10 percent. In one study, “The Usefulness of Electrical Stimulation for Assessing Pedicle Screw Placements,” no new neurological deficits were reported in a group of 662 monitored patients. ORIMtec’s internal data suggest potential abnormalities of 12% in cases utilizing pedicle screws.

While somatosensory evoked potentials provide information on the sensory nerve pathways, the more recent introduction and acceptance of motor evoked potentials (MEPs) completes the monitoring picture by evaluating the motor pathways as well. The publication, “Comparison of Transcranial Electric Motor and Somatosensory Evoked Potential Monitoring During Cervical Spine Surgery,” supports the value of motor pathway monitoring. More surgeons are using IONM as they become educated about the advantage of MEPS on operations in the cervical region.

Additional Considerations
Neurotechnologist (NT) Training: Douglas M. Enoch, MD, MS, has served as ORIMtec Medical Director since 1999, and he has been instrumental in developing our Quality Assurance and Qualification Guidelines. Dr. Enoch received his graduate certificate in neurological surgery from the Mayo Clinic in 1966 and masters of science degree in neurophysiology from the University of Minnesota in 1967.

Remote Monitoring Capability: Independent physicians provide the supervisory role to ORIMtec neurotechnologists (NTs) through online, real-time remote monitoring. Further details regarding how this oversight is accomplished can be found in the REMOTE MONITORING section under FOR SURGEONS.

Public Policy Issues: Marc R. Nuwer, MD, PhD, from the Department of Neurology at the School of Medicine at UCLA Medical Center, discusses professional public policy issues relevant to IONM in his article, “Regulatory and Medical-Legal Aspects of Intraoperative Monitoring.” Dr. Nuwer addresses billing, coding, reimbursement, staffing, device approval, and liability issues connected with intraoperative neuromonitoring.

(Please refer to the website sections labeled ABSTRACTS and CASE STUDIES for
more information on surgical monitoring and links to related publications, including
those mentioned above.)

« back to top