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The Relationship Between Intraoperative Neuromonitoring and Patient Safety

Posted: Sep 27, 2016 11:37:15 AM


Intraoperative neuromonitoring, or IONM, is a fast growing discipline that involves the monitoring of the peripheral and the central nervous systems. It is used on patients undergoing any surgical procedure where there is risk to the nervous system.  The following are just a few examples:

  • Interventional radiologic procedures
  • Cranial Neurosurgery
  • Orthopedic spinal correction
  • Vascular surgeries

How Do Patients Benefit?

Quality care is patient-centered, safe, equitable, efficient, timely, and useful. Safety is the foundation on which all other aspects of quality are built. Traditionally, surgeons have relied on such measures as monitoring blood gas contents, respiration, pulse, and blood pressure to gauge the overall health of a patient during surgery. However, such parameters only allow for limited interventions.

Intraoperative neuromonitoring, on the other hand, extends the same principle specifically to the neuraxis (axis of the central nervous system), providing the team with on-the-spot feedback during surgeries that involve the peripheral nervous system, the spinal cord, and the brain either directly or indirectly.

Real-time monitoring of the nervous system during operation procedures alerts surgeons of any evolving neurological injury. To accomplish this, sensors are placed along the neurological structures and/or muscles and are then recorded and analyzed by both an on-site neurodiagnostic technologist as well as a remote reading physician. Thus, it allows surgical teams to implement corrective measures to prevent permanent deficits and improve patient safety and surgical outcomes.

How Has This Procedure Helped?

With such prompt interventions, there are reduced post-surgical incidences, for example:

  • Paralysis
  • Sensory deficits
  • Muscle weakness
  • Any other new neurologic deficits

How the Procedure Is Performed

For an Intraoperative neuromonitoring procedure to succeed, an extensive list of neurophysiological techniques are used.  The following are just a few examples:

  • Somatosensory Evoked Potentials (SSEPs), 
  • Transcranial Motor Evoked Potentials (TCMEPs),
  • Electroencephalogram (EEG)
  • Electromyography (EMG)
  • Pedicle Screw Testing and Direct Nerve Root Stimulation (Triggerered EMG)

The surgical team then interprets data from these techniques to evaluate the integrity of the neural pathways. The procedure is quick, painless, inexpensive, and easy.  Recordings can be taken many times during surgery. It does not cause harm to the patient and is effective in reducing the risk of nerve tissue injury during surgery.

IONM with an Emphasis on Patient Safety

Patient safety is the backbone of high-quality healthcare. As with Intraoperative neuromonitoring, the focus is pegged on safety practices that help in the prevention of injury, infection, and adverse outcomes of surgical care. Health care experts are critical to the surveillance and coordination needed to reduce such adverse outcomes.

Spinal surgery involves a broad range of procedures during which the major blood vessels, nerve roots, and spinal cord are placed at a high rate of injury. IONM provides the opportunity to evaluate the functional integrity of sensitive neural elements during surgery, which calls for greater safety awareness.

The methodology of retrieving and interpreting data from different neuromonitoring modalities, like triggered electromyography and spontaneous electromyography, should be reviewed to ensure patient safety.  The clinical interpretations and step-wise decision-making processes for intervention are critical in offering high-quality results.

Multimodality neuromonitoring depends on the strengths of different kinds of neurophysiological modalities to maximize the diagnostic efficiency concerning specificity and sensitivity in the detection of impending injury. To ensure higher patient safety, specialists in this field must have specialized knowledge of the limitations and benefits of each modality in optimizing the value of intraoperative monitoring during spinal procedures.  As many different spinal surgeries continue to evolve along the path of minimal invasiveness, it is most likely that the value of the neuromonitoring can only continue to be more prominent.

Patient safety has evolved from being a health care quality movement to a more concrete essential component. In short, IONM allows for the prevention of harm to patients, with an emphasis on the system care delivery. Ultimately, IONM services contribute to a culture of safety that is a team effort between IONM providers and the surgical team.


Topics: Hospitals, Patients, IONM, Physicians
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