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The Importance of Neuromonitoring

Posted: Aug 15, 2016 4:37:24 PM


Speakers: Dr. TV Seshan (Founder of Neuro Alert), Dr. Marshal Peris (Orthopoedic Spine Surgeon at Mt. Kisco Medical Group), Dr. Jared Brandoff (Orthopedic Spine Surgeon at White Plains Hospital), Dr. Krishn Sharma (Orthopedic Spine Surgeon), and Dr. Rudolph Taddonio (Orthopedic Spine Surgeon), (4:10)

Transcripts to follow:

Dr. T.V. Sheshan, Founder of Neuro Alert:

The field of surgery is constantly improving which brings with it its own challenges. The approach to the patient is now, in many instances, vastly different and, therefore, neuromonitoring actually adds a layer of safety. (Text on the screen- Intraoperative Neuromonitoring enables surgeons to gain reliable insight into a patient’s condition during surgery. It effectively improves surgical outcomes by detecting discrepancies and alerting the surgical team who can then take immediate corrective action if necessary.) Intraoperative neuromonitoring is really intended to be used to prevent major neurological complications during various types of surgery (spinal fusion and scoliosis, discectomy, laminectomy, spinal tumor resection, craniotomies, vascular surgery, facial nerve surgery, & more). When we say complications, we basically mean, in simple terms maybe paralysis. The goal is to convey the information, in real time, to the surgical team so they can act on it and minimize the outcome of the major or catastrophic neurological complications.

A neurophysiologist, with the consent of the patient, they attach sensors to the patient to monitor the activities from the muscles, nerves, the brain– all of them analyzed, in real-time, interpreted by the neurophysiologist in the operating room, and confirmed by a remotely supervising position such as a neurologist or other experienced positions who specialize in this field and they report to the surgeons in real-time. Based on what they hear, the surgeons and the anesthesiologist may act to optimize the results of that particular surgery.” 

Dr. Marshal Peris, Orthopedic Spine Surgeon, Mt. Kisco Medical Group:

It gives us confidence that when we’re finished with the surgery, as long as there’s been no change or even improvement in the neuromonitoring signals, we know we’ve done the job that we came to do. There have certainly been instances where there have been decreases in signals in one arm or one leg during the procedure and that allows us the opportunity, at that time, to explore the nerve to make sure nothing is impinging on it.

Dr. TV Seshan, Founder of Neuro Alert:

Data is out there, where, in unmonitored patients who undergo major surgeries, where the nervous system may be at risk, the major complication rate used to be as high as 5%. But by doing intraoperative neuromonitoring , it reduces the major complication rate to 0.2%.

Dr. Jared Brandoff, Orthopedic Spine Surgeon, White Plains Hospital:

Any element of security, that I can add to the case, is of tremendous value to me and the patients. And specifically, neuromonitoring, as what I think, is becoming the standard of care for many procedures. It’s something that, for a lot of procedures I would never operate without.

Dr. Seshan, Founder of Neuro Alert:

In this day and age, where, many operations are done with minimally invasive approaches, the field of intraoperative neuromonitoring really assists the surgeon, not just in monitoring but also in the navigation aspect of where the surgeon intends to get to.

Dr. Krishn Sharma, Orthopedic Spine Surgeon: 

I think that neuromonitoring should be a part of certainly all major spinal operations, if not all spinal operations in general. I know people around the country who operate elsewhere, particularly in the south. I know somebody in South Carolina who doesn’t use monitoring at all and to me, I don’t think that’s the standard of care. I think the standard of care is to provide the safest service available and to me that means neuromonitoring only.

Dr. Rudolph Taddonio, Orthopedic Spine Surgeon: 

I use it on every one of my complex, scoliosis, reconstructive, and cervical spine cases. And I think it’s absolutely mandatory to do so.

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