Intraoperative Neuromonitoring (IONM) has claimed a critical role in complex surgeries, acting as an early warning sign for neural injury and enabling greater accuracy in surgical correction. Once utilized as a supplemental technique for safety, IONM has become increasingly more essential in the surgical suite, especially for procedures involving the spinal cord. A panel of highly experienced neurophysiologists and neurosurgeons, alongside SpecialtyCare IONM professionals, recently came together to discuss the impact of IONM on today’s complex surgeries. 

The panel included Dr. Dan Hedequist, Chief of Spine Surgery at Children’s Hospital in Boston; Dr. Hasan Zaidi, neurosurgeon at Mass General Brigham who focuses primarily on complex revision spine surgery; Dr. Mitali Bose, a principal surgical neurophysiologist and clinical training leader; Matt Toczylowski, Director of Clinical Performance and Innovation at SpecialtyCare; and Dr. Joe Doria, Medical Director at SpecialtyCare, a neurologist subspecializing in clinical neurophysiology. The conversation was hosted by Brian Zimmerman, an associate vice president with Becker’s Healthcare. The following is a summary of their discussion about the current state of IONM, its distinct benefits for spinal surgery, and where it’s headed in the future.

An “Early Warning System”: How IONM Is Improving Accuracy and Reducing Risk

The goal of IONM is to prevent or even reverse the potential of neurological injury. Carefully placed sensors notify the monitoring team when surgical action is putting specific nerve function at risk; the monitoring team communicates with the surgical team to make adjustments in real time to preserve function. In this way, IONM creates guardrails that allow surgeons to pinpoint the most effective actions and maintain a key level of safety, keeping in scope both short-term and long-term outcomes for the patient.

IONM modalities give surgeons a window into variables that may be causing changes in nerve signals, from perfusion and blood flow issues to mechanical pressure or injury — even anesthesia-related factors. Monitoring can be especially critical during procedures such as scoliosis correction, deformity surgery, vertebral column resections, revision spine surgery, tumor resections. It can even inform instrumentation placement and patient positioning.

Dr. Hedequist identifies IONM as much more than a supplemental practice. “At Children’s … and I think nationally, in most places, monitoring is really a standard of care,” he says. “So almost 100% of children undergoing any spine operation are going to undergo neurological monitoring.”

Dr. Zaidi echoes the sentiment for spinal surgeries in adults. “…Where I have found neuromonitoring to be the most helpful in the adult world is typically… a thoracal lumbar deformity, but these are elderly patients with disease throughout their spine. It’s not like a kid who has a thoracal lumbar deformity, but no cervical or distal lumbar disease. These patients have terrible looking degenerative changes throughout their spine,” he says. “So I use at almost every stage of the case, and I can’t think of one stage that I find more important than the last.”

The Importance of Team Trust and Communication

Team communication and trust can be a vital component of success in complex surgeries involving IONM. Monitoring is more than simply passing along data; the monitoring team is integrated with the surgical team, working alongside them to interpret changes and identify the best course of action.

Matt Toczylowski discusses what it’s like to collaborate in the surgical suite. “In real time, you’re working with the surgeon. The surgeon is telling you the steps of the procedure. We’re constantly communicating back to them what we are seeing,” he says. “… Even when everything is going perfectly, we have a constant level of communication so that if something were to happen, we know where to look first.”

Moreover, Dr. Zaidi stresses the importance of having a trustworthy IONM team that proactively interfaces with clinical staff. “It’s not like we’re getting raw data from our neuromonitoring team. This is digested information. And so when it’s brought to our attention, it’s information that is real because there is a phenomenon of decision fatigue for physicians. … So you really need a team that’s there helping you and digesting this information and processing it because it’s a lot to take in as just one physician,” he says. “… When you’re taking on a particularly difficult case, you have to have trust that the entire team is on the same page. And when you have that ability to know that you have good monitoring, it allows you to push the envelope just a little bit further each time.”

Dr. Joe Doria emphasizes that, for this reason, SpecialtyCare focuses on rigorous training, competency assessments, assigning experienced personnel to complex cases, and maintaining consistent OR teams to build long-term trust with surgeons. A high level of experience, comfort, and familiarity fosters strong communication and improves the quality of procedures.

Innovations in Neuromonitoring Are Expanding Safety and Capability in Surgery

In the past 15-20 years, IONM has advanced to the point where it is fundamentally transforming complex spinal surgeries. Improved monitoring has given surgeons greater confidence to perform larger deformity corrections, more aggressive decompressions, complex osteotomies, and high-risk thoracic procedures. Now AI has entered the conversation as a pathway for improved signal analysis, earlier detection of changes in nerve signals, predictive risk modeling, and even additional modalities. Surgeons are optimistic about the implementation of AI into IONM and how much more the technology can evolve. 

Dr. Bose says that neuromonitoring is already progressing quickly. “I think our field is progressing really, really fast, and we are developing new modalities,” she says. “Every year in every conference, I see new things coming up, modalities being experimented, being added.”

In light of the developments that have taken place in the last couple decades, Dr. Hedequist emphasizes that IONM is no longer optional for complex spinal surgeries. “I just think it’s become such a standard of care that it shouldn’t even be a discussion point with hospital administrators anymore,” he says. “It’s very clear in pediatric deformity, adult deformity, and spine surgeon in general — intraoperative neuromonitoring, whether it’s motor VOC potential, center evoke potentials, triggered EMGs, D-wave monitoring, they’ve all been shown to be part of the neuroprotection of your patient. And there’s so much literature now that … it shouldn’t be that hard to go to a hospital administrator and say that. It’s pretty non-defensible not to use it.”

Integrate an Experienced IONM Team into Your Surgical Suite

SpecialtyCare is the largest provider of IONM in the nation, and we’re ready to help you integrate an experienced IONM team into your surgical suite to help make your complex surgeries safer and more effective. In 2025, we covered 130,000 intraoperative neuromonitoring cases across roughly 750 hospitals in the US.

Our robust, highly trained team includes dozens of oversight neurologists and around 700 surgical neurophysiologists and technicians in the OR to support these cases. Our IONM professionals are all CNM certified, and they regularly have their competencies evaluated, reevaluated, and reassessed as the field of neuromonitoring advances. If you’re ready to implement IONM into your standard of care and improve both short-term and long-term outcomes for your spinal surgery patients, get in touch with us today!