What is INOM?

Intraoperative Neuromonitoring (IONM) is the monitoring of the central and peripheral nervous systems of patients undergoing surgical procedures.

Intraoperative Neuromonitoring (IONM)

IONM helps improve patient outcome by carefully assessing the functional status of nervous tissue, including spinal column tracts, eloquent brain regions, and peripheral nerve. This neurophysiologic information helps the surgeon perform a safer and sometimes more thorough procedure.

There is an assortment of monitoring tools and techniques that may be used by your surgeon in different combinations in order to provide the surgeon useful information regarding your condition as your surgery progresses.


IONM is a powerful tool that provides early warning feedback to the surgical team concerning the sensory and motor function of the spinal cord and cauda equina. It has become a standard of care for many procedures. IONM can be helpful in clarifying anatomical structures that have been distorted by degenerative disease, congenital anomalies, revision surgery, tumor, or inflammatory processes that may obscure normal anatomic relationships and surgical landmarks


IONM allows surgeons to improve surgical outcomes and reduce incidences of post-operative neurophysiological deficits by over 50%.

The combined use of SSEPs, EMGs and tceMEP techniques can produce reproducible and accurate data. The specialized intraoperative tests are designed to detect any deterioration in the functionality of nural pathways. These highly specialized studies are the only tools in the operating room that can investigate the functional status of the nervous system, while imaging studies like fluoroscopy, CT scans or MRI are visual aids that only look at the structure or anatomy of a particular body part or organ. Only intraoperative neurophysiological monitoring can tell if the neural pathways at risk from the surgery are still functional.

The American Academy of Neurology has recognized IONM as an effective and essential means to prevent complications and identifying neural structures during surgical procedures.

When is IONM used?

Your surgeon will decide if IONM is right for your surgery. Typically, IONM is used during the following:

Spinal Procedures  Spinal cord cases—cervical, thoracic and lumbar  Spinal instrumentation procedures—total disc replacement, discectomy/laminectomy, corpectomy and decompressions  Spinal Embolizations—spinal tumors, AVM’s and dural AV fistulas Neurosurgical Procedures  Craniotomies placing cranial nerves or cortical blood flow at risk, microvascular decompressions and spinal cord tumors
Vascular Procedures  Carotid endarterectomy and aortic aneurysm
Peripheral Nerve Procedures  Acetabular (hip) fractures and hip arthroplasty revisions  Brachial plexus repair  Peripheral nerve repair
Otolaryngologic (Head/Neck) Procedures  Thyroidectomies and parotid tumor resection