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A main goal of our practice is to make sure that our patients understand what is occurring every step of the way. We want you to know the process works, what you can expect, and what your options are. This is your body, your life, and your choice. We want you to be educated enough to ask the right questions and be able to make the best decision that's right for you.

What is Intraoperative Neuromonitoring, or IONM?

  • Intraoperative Neuromonitoring (also called intraoperative monitoring, IOM, or intraoperative neurophysiologic monitoring), is testing that is done while a patient undergoes surgery to watch the function of the brain, spinal cord, nerve roots, and peripheral nerves in real time. This helps the surgeon know if the patient's sensory, motor, or vascular function (blood flow) is being impaired by an action performed within the course of the surgery. By alerting the surgeon of any complications as they occur, the surgeon can immediately reverse or address whatever action was taken, which may have been the cause of the neurologic change. This way, the patient has a greater chance to make a full recovery, therefore preventing permanent damage to his or her neurologic function.

Do I need Intraoperative Neuromonitoring for my procedure?

  • Many procedures are indicated and can benefit from the use of Intraoperative Neuromonitoring. Please ask your surgeon, or contact our PATIENT CONCIERGE SERVICE to find out if your surgery qualifies. Many spinal, general orthopedic, brain, vascular, peripheral nerve, ENT (Ear, Nose, and Throat), and prostate surgeries are able to be monitored with much success and benefit to the patient.

What types of surgeries and conditions is IOM useful for?  

  • A non-inclusive list of types of surgeries and conditions is provided below. However, due to advancements in medicine, new procedures are being successfully monitored every day!

Note that even patients who are not a good candidate for neuromonitoring may still be eligible for our exclusive PATIENT CONCIERGE SERVICE which will get you in touch with the top physicians in their field to quickly and skillfully address your pain and symptoms.

Eligible Patients:

  • Patients with Neck or back pain

Patients in need of any orthopedic procedure, including:


Orthopedic Spine Surgery

  • Minimally Invasive Spine Surgery

  • Arthroscopic Surgery

  • Discectomy

  • Laminectomy

  • Spinal Fusion

  • Disc Replacement

  • Spinal Cord Stimulator Implant

  • Anterior Cervical Discectomy and Fusion (ACDF)

  • Cervical Laminectomy

  • Revision Spine Surgery

  • Spinal Cord Tumors


General Orthopedic Surgery, including conditions related to:


  • ACL Tear

  • Meniscus Tear

  • Arthritic Knee

  • Bursitis

  • Tendonitis

  • Sprain or Strained Ligaments


  • Rotator Cuff Disorder

  • Labral Tear

  • Arthritic Shoulder

  • Bursitis

  • Tendinitis

  • Instability

  • Shoulder Separation

  • Frozen Shoulder


  • Broken Ankle

  • Chronic Ankle Instability

  • Fracture

  • Arthritic Ankle

  • Gout

  • Tendinitis

  • Plantar Fasciitis


  • Hip Fracture and-or Dislocation Treatment

  • Hip Replacement

  • Hip Replacement Revision

  • Hip Resurfacing


Other Referrals Accepted:

Hand Procedures:

  • Carpal Tunnel Release

  • Cubital Tunnel Release


 Disorders of the Ear, Nose, and Throat (ENT):

  • Thyroidectomy

  • Parotidectomy


Neurologic Endovascular Procedures:

  • Stroke Interventions

  • Aneurysm Coiling

  • AVM and Tumor Embolizations

  • Carotid Stenting


Vascular Procedures:

  • Open Heart Surgery

  • Carotid Endarterectomy

Brain Surgery:

  • Brain Tumor, Pituitary Tumor Resection

  • Chiari Malformations

  • Open Arteriovenous Malformations (AVM)

  • Trigeminal Neuralgia 

  • Aneurysms

  • Hydrocephalus

Positioning-related Surgery:

(Cases where the patient is at a high risk for positioning related complications)

  • Bariatric surgery

  • General Surgery


Urology :

Prostate surgery (greater accuracy than  visual nerve sparing techniques)

  • Open Surgery

  • Laparoscopic Surgery

  • Robotic-Assisted Laparoscopic Radical Prostatectomy

As an additional non-surgical service, we also offer:

Clinical EEG:

  • Clearance for combat sports

  • Routine Testing 



What kind of tests will you be running during my procedure?


  • There are many tests in intraoperative monitoring that may be suitable for your surgery. Some of these tests are listed below:

  • Somatosensory Evoked Potentials (SSEPs): This tests the sensory function in the nerves, brain, and spinal cord by stimulating peripheral nerves and monitoring the signal at it moves through the spinal cord and into the somatosensory cortex of the brain.

  • Transcranial Motor Evoked Potentials (TCMEPs): This tests the motor conduction in the spinal cord by stimulating the brain at the motor cortex and recording from peripheral muscles in the patient's upper and lower extremities (hands and feet). This will ensure that the patient is able to move without any deficits postoperatively.

  • Free Run Electromyography (EMG): This is a passive test that is able to detect nerve and nerve root irritation caused by surgical manipulation, traction, and other forces. Any disturbance in the nerves or nerve roots will cause muscle movement, which is then detected by our highly specialized equipment. 

  • Pedicle Screw Testing, Direct Nerve Root Stimulation (Triggered EMG): This is an active test related to free Run EMG. In this test, instead of passively detecting problems caused by forces and manipulation, electricity is used to stimulate the screws or nerve roots directly in order to determine screw placement, nerve mapping within the surgical site, or the integrity of the nerve or nerve root itself. 

  • Electroencephalography (EEG): EEG is an electrophysiological monitoring method to to record electrical activity of the brain. Intraoperatively, EEG can test depth of anesthesia, and even vascular changes such as a stroke. Clinically, it can be used to detect brain abnormalities, such as a seizure disorder. 

  • H Reflex, F Wave: These tests are nerve conduction studies that we use to detect possible spinal cord disruption through the use of the normal reflex action within the body.  

  • Train of Four: This is an ancillary test that we run in conjunction with the other motor modalities (TCMEP, EMG, Triggered EMG) to test the recovery of muscle relaxant, or muscular blockade, that is given to the patient. A result of 4/4 twitches assures the reliability of our motor tests to assure the maximum protection for our patients. 

  • Motor Mapping and Cortical Stimulation: These techniques are utilized in some specialized craniotomies to map out the central sulcus as well as the sensory and motor strips.

  • Compound Muscle Action Potential (CMAP) and Sensory Nerve Action Potential (SNAP): These tests are useful in some peripheral nerve surgeries to detect changes in nerve and muscle conduction and function. 

  • Auditory Brainstem Response (ABR): This test is utilized in some skull base and complex procedures to monitor brain stem function, as well as the 8th cranial nerve.  This done through a series of clicks delivered through small earphone inserts.

  • Visual Evoked Potentials (VEP): Through the use of goggles and different patterns of visual stimuli, the visual pathways in the brain are able to be monitored. This test is most useful in a clinical setting. 

Who will be performing the intraoperative neuromonitoring for my procedure?

  • We only employ board certified CNIM (Certification Neurophysiologic Intraoperative Monitoring) technologists (also called intraoperative neurophysiologists) who have many years of experience monitoring cases in the operating room. Our colleagues include professionals who own Master's degrees in Neuroscience, as well those who hold double board certifications in our field of study. Education is very important to us. We are also affiliated with a neurophysiology school, named "Grace Institute of Neurophysiology and Technology," located in Frisco TX, where some of our colleagues also hold faculty positions. In addition, for every case that we monitor, we partner with a board certified neurologist who remotely connects to the data and interprets it in real time. You can always feel secure that you are in the hands of well trained, experienced providers at every step of the way!

For additonal information:

Contact us 24 hours a day, 7 days a week, 365 days a year.


To learn more, return to PATIENTS

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