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Intraoperative neuromonitoring (IOM) is a sophisticated safety technology that provides continuous, real-time monitoring of your spinal cord, nerve roots, and peripheral nerves during cervical spine surgery. While you are under general anesthesia, a specialized neurophysiologist uses advanced electrical testing to track nerve function second by second, alerting Dr. Wascher immediately if any changes occur that could indicate potential nerve injury. This allows him to make immediate adjustments to protect your neurological function before any permanent damage occurs.
Dr. Thomas M. Wascher uses intraoperative neuromonitoring on all major cervical spine procedures performed at Wascher Cervical Spine Institute. Over his 33+ year career performing 4,500+ cervical spine surgeries, IOM has become an essential component of his comprehensive approach to patient safety. Combined with his microscopic surgical technique and advanced intraoperative imaging, IOM provides an additional layer of protection that helps achieve his exceptional safety record.
IOM has become the standard of care for complex cervical spine procedures nationwide. Research shows that when IOM is used, post-operative neurological deficits occur in only 0.1 to 0.2% of patients overall. The technology has proven sensitivity rates of 92% and specificity rates of 98%, making it one of the most reliable safety measures in modern spine surgery.
Intraoperative neuromonitoring functions as an invisible safety net throughout your surgery. After you are under general anesthesia but before the surgical procedure begins, a trained neurophysiologist places small electrodes on your scalp, hands, feet, and near specific muscles and nerves. These electrodes are tiny needles or adhesive patches that cause no pain or discomfort since you are already fully anesthetized.
Throughout the entire surgical procedure, the neurophysiologist continuously sends small electrical signals through your nervous system and measures how quickly and strongly those signals travel. Normal, healthy nerve function produces consistent patterns on the monitoring equipment. Any deviation from these patterns indicates potential stress or compression on a nerve or the spinal cord.
If the monitoring detects changes that exceed safe thresholds, the neurophysiologist immediately alerts Dr. Wascher. He can then take corrective action before any permanent damage occurs. This might involve adjusting your position on the operating table, removing a surgical instrument that is applying pressure, repositioning hardware, checking blood pressure or body temperature, or modifying the surgical approach. The key advantage is that these corrections happen in real time while the problem is still reversible.
Dr. Wascher uses IOM on all complex and high-risk cervical spine procedures, including:
Anterior Cervical Corpectomy: When removing vertebral body bone to decompress the spinal cord, IOM monitors spinal cord function continuously as decompression progresses. This is particularly critical in OPLL cases where the spinal cord is severely compressed.
Multilevel Cervical Fusion: Procedures involving three or more spinal levels carry higher risk due to the extent of surgical manipulation. IOM provides continuous feedback throughout these longer, more complex operations.
Cervical Myelopathy Surgery: When the spinal cord is already compressed and compromised, it is more vulnerable to additional stress during decompression. IOM ensures the decompression itself does not cause further injury.
Posterior Cervical Decompression with Instrumentation: Screw placement in posterior fusion procedures benefits greatly from triggered EMG monitoring to confirm proper hardware position.
Revision Cervical Spine Surgery: Previous surgery creates scar tissue and altered anatomy that increases surgical complexity and risk. IOM provides enhanced safety during revision procedures.
Primary Cervical Tumor Surgery: Tumor removal near the spinal cord requires meticulous monitoring to balance complete resection with neurological preservation
Effective intraoperative neuromonitoring requires seamless coordination among three key team members:
The Neurophysiologist places all monitoring electrodes, runs continuous electrical tests throughout surgery, interprets the complex waveform data in real time, and immediately notifies the surgeon of any concerning changes. These specialists undergo extensive training to distinguish true neurological changes from false alarms caused by anesthesia, temperature, or positioning.
The Anesthesiologist maintains optimal anesthesia depth and body temperature while avoiding anesthetic agents that interfere with nerve signal transmission. Certain inhalational anesthetics can suppress nerve signals and create false positive readings, so careful anesthetic management is critical for reliable monitoring.
The Surgeon must be able to rapidly interpret monitoring alerts within the surgical context and take immediate corrective action. Dr. Wascher's extensive experience with IOM allows him to quickly determine whether changes represent true nerve stress requiring intervention or physiological variations that require anesthesia adjustments.
Vanessa had years of neck pain leaving her unable to even do her daily work. But with Dr. Wascher’s quick and timely intervention that included multiple viewings of MRIs, muscle and nerve tests, followed by a 3-Level Anterior Cervical Fusion, she is now happy without any neck issues. “I can happily say that by following the recommendations of Dr. Wascher, I am now pain-free,” says Vanessa as she talks about how great Dr. Wascher and his team were to work with.
When Nanette experienced deep pain in her shoulder, she got tests performed, only to discover that she, in fact, had issues with her neck instead. After a few MRIs and scans, she contacted Dr. Wascher, who told her that she has bone spurs going into the spinal cord. Within a span of 3 weeks, she was able to go through surgery and get on the road to recovery. “I cannot say enough about Dr. Wascher’s expertise and empathy”, says Nanette as she joins an ever-growing community of people who, through Dr. Wascher and his team, have found happiness again.
