Modalities

IONM Modalities Offered

Modality

Description

Surgical Applications

Somatosensory Evoked Potentials (SSEP) Spinal fusion procedures and spinal cord surgeries have better outcomes with the use of Somatosensory Evoked Potentials (SSEP). Generating electrodes are placed on the arms and legs, usually at the wrists and ankles and stimulate the peripheral nerves. The generated response travels from the peripheral nerve, through the dorsal columns of the spinal cord and arrives at the sensory cortex in the brain, where the responses are recorded. The amplitude and time latency of these responses are continuously monitored as they travel through the surgical site.
  • Cervical Fusions
  • Thoracic Fusions
  • Lumbar Fusions
  • Laminectomy
  • Foraminotomy
  • Discectomy
  • Spinal Cord Tumors
  • Spinal Cord Stimulator Placements
  • Some Craniotomies
  • Odontoid/Dens Fractures
  • Scoliosis Instrumentation
  • Vertebral Fractures
  • Total Disc Replacements
  • Tethered Cord Release
  • Carotid Endartertomies
  • Aneurysm Clippings
  • Acetabular Fractures
  • Verterbroplasties
Trans-Cranial Motor Evoked Potentials (TcMEP) Trans-Cranial Motor Evoked Potentials (TcMEP) are generated by stimulating electrodes applied to the motor cortex in the brain and recorded by electromyographic responses in the extremities. Feedback can be obtained instantly due to the amplitude of these responses. TCMEP is the most effective way to monitor pyramidal motor pathways located in the anterior portion of the spinal cord. The spinal cord could be at risk if these motor pathways are interrupted during a neurosurgical operation.
  • Cervical Fusions
  • Thoracic Fusions
  • Lumbar Fusions
  • Spinal Cord Tumors
  • Scoliosis Instrumentation
  • Tethered Cord Release
  • All surgeries that place motor pathways at risk
Brainstem Auditory Evoked Potentials (BAEP) Brainstem Auditory Evoked Potentials (BAEP) can reduce the probability of hearing loss during surgery where brainstem or the auditory pathway is at risk. The auditory system is stimulated using click stimuli through earplug inserts. The brain reacts to this stimulus by sending out evoked potentials, which are recorded from electrodes placed on the head and near the ears. The presence and time latency of these responses are continuously monitored throughout the surgery.
  • Posterior Fossa Surgery
  • Acoustic Neuromas
  • Brain Tumor Surgeries
  • Vestibular Nerve Resections
  • VII or VIII Cranial Nerve Microvascular Decompressions
  • Brainstem Retraction Surgery
  • Aneurysm Clippings
Electroencephalogram (EEG) Electroencephalogram (EEG) equipment is used to monitor surgeries where the patient’s cerebral cortex may be at risk. Electrodes will be placed on the patient’s scalp in order to record electric signals that are converted into waveforms. Changes in these waveforms could indicate damage to the neural system or a negative reaction to anesthesia.
  • Evaluation of anesthetic effect during all IONM surgeries
  • Carotid Endarterectomies
  • Aneurysm Clippings
Free Run Electromyography (EMG) Electromyography (EMG) is used in surgeries where the cranial nerves, peripheral nerves, or nerve roots are at risk. EMG monitors the muscles that are innervated by the aforementioned nerves. Our trained technologists can determine whether one of these nerve sites is being irritated during the surgical procedure by monitoring discharge activity generated at the corresponding muscle sites. EMG testing feedback is obtained immediately and can be interpreted as a possible neurogenic discharge that might cause nerve injury.
  • Cervical Fusions
  • Thoracic Fusions
  • Lumbar Fusions
  • Laminectomy
  • Foraminotomy
  • Discectomy
  • Spinal Cord Tumors
  • Spinal Cord Stimulator Placements
  • Peripheral Nerve Surgeries
  • Cranial Nerves III, IV, V, VI, VII, IX, X, XI, XII
  • Nerve root decompressions
  • Scoliosis Instrumentation
  • Vertebral Fractures
  • Total Disc Replacement
Triggered EMG Pedicle Screw Stimulation Using a monopolar stimulation probes for pedicle screw placement testing, technologists can inform surgeons of the compound muscle action potential (CMAP) threshold based on the stimulus intensity that is recorded by electrodes placed at the corresponding muscle sites innervated by the nearest nerve root to the screw being stimulated. Studies have shown that higher CMAP threshold values during pedicle screw stimulation have a greater percentage of predicting safe pedicle screw placement.
  • Spine instrumentation involving pedicle screw placement
Direct Nerve Stimulation Like pedicle screw stimulation testing, triggered EMG can be used by stimulating on or near nerve tissue. Based on compound muscle action potentials (CMAP) recorded at innervated muscles, the technologist can provide accurate information to the surgeon in determining where neural tissue is located during the surgery.
  • Peripheral Nerve Surgery
  • Thyroidectomies
  • Parotidectomies
  • Lateral Lumbar Fusions
  • All Spine Surgeries
  • Any surgery where nerve tissue needs to be identified
Sensorimotor Cortex Localization (Cortical Mapping) Sensorimotor cortex localization is a test that can be used to identify sensory and motor cortices in the brain. This test is performed by placing a silicone paddle with multiple electrode sites directly on the surface of the brain. Using SSEP modality protocol, the median nerve is stimulated. The resulting response is then recorded by the paddle electrode to localize the aforementioned cortices.
  • Brain Tumor Surgeries