Premier IONM data and research.


Because our clinicians are teamed with surgical teams in thousands of cases across the country, SpecialtyCare is able to gather IONM data on techniques that typically aren’t known in remote medical facilities or by other providers with a more limited research range. This is why we’re an industry leader in intraoperative neuromonitoring IONM data.

With the creation of SCOPE, the SpecialtyCare Operative Procedural Registry, SpecialtyCare has the largest clinical database of its kind. Members of our medical office analyze case data and share the scientific findings to our clinical professionals so that the evidence-based trends and best practices can be shared with surgeons and OR teams across the nation, which also brings innovation at the local level.

IONM Data & Study Sample

SpecialtyCare is on the cutting edge of IONM data and research. For example, we recently discovered there is a link between IONM and lower opioid use in recovery for spinal surgery. In a study of over 8,400 patients, cervical spine patients who had surgeries that included IONM were much less likely to be prescribed opiates within the year following surgery compared to patients that did not have IONM included in their surgery.

This same study also determined there was a reduction on the number of readmissions post-surgery when IONM was used. This outcome was also confirmed by another study that was presented by the North American Spine Society (NASS) in 2016 that directly linked a lower number of post-operative injuries in patients that had neuromonitoring during their surgery.

This proved to be a great scientific find within the context of the country’s ongoing opioid crisis. The Centers for Disease Control (CDC) has made opioid misuse of the United States’ top public health challenges. Any changes to medical practices that reduce demand on opioids can have positive health benefits for the industry overall.


SpecialtyCare Advisory Boards

In regards to IONM data and research, SpecialtyCare also uses the medical expertise of advisory boards that include healthcare experts and industry-leading physicians, surgeons, anesthesiologists and clinicians. They work closely with our chief medical officer, as well as members of our medical office. Together, they provide:

  • Insight into perfusion, neuromonitoring, surgical assistance, and clinical technician environments
  • Recommendations through IONM data to advance medical systems, including quality indicators, procedural guidelines, and improvement initiatives
  • Guidance to ensure the best possible care to our patients
  • Assistance in developing and maintaining positive relationships with the medical, perfusion, surgical assistance, and clinical technician communities
  • Collaborations that include ideas for growing hospitals’ business and for improving recruitment of clinical staff
  • Ongoing input for our continuing education programs

IONM Research Articles

Bring a proven history of research and innovation to your world-class surgical teams. We were among the first to introduce routine use of transcranial electric motor evoked potentials (tceMEP) in monitoring spine and intracranial surgery. And, we developed numerous tceMEP refinements and innovations, such as customized anesthesia protocols for optimized tceMEP recording and techniques for monitoring nerve root function during spine surgery, brachial plexus function during shoulder reconstruction, and sciatic nerve function during acetabular (pelvic) surgery.


Webster CM, Hokari M, McManus A, Tang XN, Ma H, Kacimi, R., Yenari, MA. (2013) Microglial P2Y12deficiency/inhibition protects against brain ischemia. PLoS ONE 8(8):e70927. doi:10.1371/journal.pone.0070927

Luginbuhl A, Schwartz DM, Sestokas AK, Cognetti D, Pribitkin E: Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy. Laryngoscope 122:110-115,

Ramesh V, Nair D, Zhang SX, Hakim F, Kaushal N, Kayali F, Wang Y, Li RC, Carreras A, Gozal D. Disrupted sleep without sleep curtailment induces sleepiness and cognitive dysfunction via the tumor necrosis factor-α pathway. J Neuroinflammation 2012, 9:91.

Stricker PA, Sestokas AK, Schwartz D, Bhalodia V, Pahwa A, Dormans JP, et al: Effects of intrathecal morphine on transcranial electric motor-evoked potentials in adolescents undergoing posterior spinal fusion. Anesth Analg 115:160-169, 2012.

Telleria, J, Safran, MR, Gardi JN, Harris AHS, Glick JM. Risk of sciatic nerve traction injuryduring hip arthroscopy – is it the amount or duration? An intra-operative nerve monitoring study. J Bone Joint Surg Am, 94(22): 2025-32, 2012.

Ambardekar AP, Sestokas AK, Schwartz DM, Flynn JM, Rehman M: Concomitant
hypertension, bradycardia, and loss of transcranial electric motor evoked potentials during pedicle hook removal: Report of a case. J Clin Monit Comput 24:437-440, 2010.

Falowski M, Celii A, Sestokas AK, Schwartz DM, Matsumoto C, Sharan A. (2010) Awake vs. asleep placement of spinal cord stimulators: a cohort analysis of complications associated with placement. Neuromodulation: Technology at the Neural Interface 14(2):130-135.

Lieberman JA, Berven S, Gardi J, Hu S, Lyon R, MacDonald DB, Schwartz D, Sestokas A, Yingling C. Letter & rebuttal to Modi et al. Spine J 35(6):717-720, 2010.

Mahmoud M, Sadhasivam S, Salisbury S, Nick TG, Schnell B, Sestokas AK, Wiggins CW, Samuels P, Kabalin T, McAuliffe J (2010) Susceptibility of transcranial electric motorevoked potentials to varying targeted blood levels of dexmedetomidine during spine surgery. Anesthesiology 112:1364-1373.

Roper MT. (2010) Potential neurological risks during a titanium rib procedure and appropriate intraoperative neurophysiologic monitoring modalities. American Journal of Electroneurodiagnostic Technology 50(3):199-210.

Sloan TB, Schwartz DM, Bell SD, Sestokas AK. Total intravenous anesthesia (TIVA) alternatives in the face of a propofol shortage. American Society of Neurophysiological Monitoring 17(6):2009.

Bhalodia VM, Sestokas AK, Tomak PR, Schwartz DM: Transcranial electric motor evoked potential detection of compressional peroneal nerve injury in the lateral decubitus position. J Clin Monit Comput 22:319-326, 2008.

Roper MT, Scott MT, Mura J. (2008) Vertebral artery reconstruction using microanastomosis and intraoperative neuromonitoring: a case report from Santiago, Chile. American Journal of Electroneurodiagnostic Technology 48(2):79-92.

Bose B, Sestokas AK, Schwartz DM: Neurophysiological detection of iatrogenic C-5 nerve deficit during anterior cervical spinal surgery. J Neurosurg Spine 6:381-385, 2007.

Mahmoud M, Sadhasivam S, Sestokas AK, Samuels PW: Loss of transcranial electric motor evoked potentials during pediatric spine surgery with
dexmedetomidine. Anesthesiology 106:393-396, 2007.

Schwartz DM, Sestokas AK, Hilibrand AS, Vaccaro AR, Bose B, Li M, et al: Neurophysiological identification of position-induced neurologic injury during anterior cervical spine surgery. J Clin Monit Comput 20:437-444, 2006.

Nagda SH, Rogers KJ, Sestokas AK, Getz CL, Ramsey ML, Glaser DL, et al: Neer award 2005: Peripheral nerve function during shoulder arthroplasty using intraoperative nerve monitoring. J Shoulder Elbow Surg 16:S2-8, 2007.

Bose B, Sestokas AK, Schwartz DM: Neurophysiological monitoring of spinal cord function during instrumented anterior cervical fusion. Spine J 4:202-207, 2004.

Nissen AJ, Sikand A, Welsh JE, Curto FS, Gardi JN. A multifactorial analysis of facial nerve results in surgery for cerebellopontine angle tumors. ENT Journal 76:37-40, 1997.

Vogel RW, Green JT, Steinmetz JE. (2004). Post-training inactivation of the cerebellar interpositus nucleus disrupts performance of the classically conditioned eye-blink response and some learning-related activity of Purkinje cells in the anterior cerebellar cortex. Integrative Physiological and Behavioral Science 39(1):76-77.

Woodruff-Pak DS, Vogel RW, Wenk GL. (2003). Mecamylamine interactions with
galantamine and donepezil: effects on learning, acetylcholinesterase, and nicotinic acetylcholine receptors.Neuroscience 117(2):439-447.

Bose B, Wierzbowski LR, Sestokas AK: Neurophysiologic monitoring of spinal nerve root function during instrumented posterior lumbar spine surgery. Spine J (Phila Pa 1976) 27:1444-1450, 2002.

Schwartz DM, Li M, Vaccaro, A, Hilibrand A, Mirarchi MN, Matsumoto CI, Sestokas, AK, Stransas S, Albert T. Transcranial electric motor-evoked potential monitoring as an early indicator of emerging thoracic spinal cord ischemic injury. Spine J 2(5 supplement):92-93, Sep 2002.

Woodruff-Pak DS, Vogel RW, Ewers M, Coffey J, Boyko OB, Lemieux SK. (2001). MRI-assessed volume of cerebellum correlates with associative learning. Neurobiology of Learning and Memory 76(3):342-357.

Woodruff-Pak DS, Vogel RW, Wenk GL. (2001). Galantamine: effect on nicotinic receptor binding, acetylcholinesterase inhibition, and learning. Proceedings of the National Academy of Sciences (USA)98(4):2089-2094.

Nissen AJ, Sikand A, Curto FS, Welsh JE, Gardi JN. Value of intraoperative threshold stimulus in predicting postoperative facial nerve function after acoustic tumor resection. Am. J. Otology 18:249-51, 1997.

Nissen AJ, Sikand A, Welsh JE, Curto FS, Gardi JN. A multifactorial analysis of facial nerve results in surgery for cerebellopontine angle tumors. ENT Journal 76:37-40, 1997.

Schwartz DM, Drummond DS, Schwartz JA, Wierzbowski LR, Sestokas AK, Pratt RE Jr, et al: Neurophysiological monitoring during scoliosis surgery: a multimodality approach. Seminars in Spine Surgery 9:97-111, 1997.

Schwartz DM, Schwartz JA, Pratt RE,Jr, Wierzbowski LR, Sestokas AK: Influence of nitrous oxide on posterior tibial nerve cortical somatosensory evoked potentials. J Spinal Disord 10:80-86, 1997.

Schwartz DM, Gardi JN. Intraoperative monitoring of motor cranial nerve function: position statement and practice guidelines. ASNM Monitor 3 1995.

Yingling CD, Gardi JN Intraoperative monitoring of facial and cochlear nerves during acoustic neuroma surgery. Otolaryngol Clin of N Am 25:413-448, 1992.

Jewett DL, Martin WH, Sininger YS, Gardi JN. The 3-channel Lissajous’ trajectory of the auditory brain-stem response. I, Introduction and overview. Electroenceph. clin. Neurophysiol 68:323-26, 1987.

Martin WH, Sininger YS, Jewett DL, Gardi JN, Morris JH. The 3-channel Lissajous’ trajectory of the auditory brain-stem response II. Methodology, Electroenceph clin Neurophysiol 68:327-32, 1987.

White MW, Merzenich MM, Gardi JN. Multi-channel cochlear implants – Channel interaction and processor design. Arch Otolaryngol 110:493-501, 1984.

Gardi JN, Merzenich MM. The effect of high-pass noise masking on the scalp-recorded frequency following response in cats and humans. J Acoust Soc Am 65:1491-1500, 1979.

Gardi JN, Salamy A, Mendelson T. Scalp-recorded frequency following responses in neonates. Audiology18:494-506, 1979.

Schwartz DM, Sestokas AK, Dormans JP, Vaccaro AR, Hilibrand AS, Flynn JM, et al: Transcranial electric motor evoked potential monitoring during spine surgery: is it safe? Spine J (Phila Pa 1976) 36:1046-1049, 2011.

Gharib SA, Khalyfa A, Abdelkarim A, Ramesh V, Buazza M, Kaushal N, Bhushan B, Gozal D. Intermittent hypoxia activates temporally coordinated transcriptional programs in visceral adipose tissue. J Mol Med(Berl). 2012, 90(4):435-45.


Doan AT, Vogel RW, and Sestokas AK (2013). Intraoperative Neuromonitoring during Spine Surgery. In AR Vaccaro, BW Su, K Chiba, et al (Eds.), The Spine (1st Edition), pages TBD.

Sestokas AK, Schwartz DM: Interventional neuroradiology, in Koht A, Sloan TB, Toleikis JR: Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals, New York: Springer, 2012, pp 737.

Schwartz DM, Sestokas AK, Dormans JD: Intraoperative neurophysiological monitoring during corrective spine surgery in the growing child, in Akbarnia BA, Yazici M, Thompson GH: The Growing Spine: Management of Spine Disorders in the Young Child, Berlin: Springer, 2011, pp 515.

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Listen to Checking the Vitals

In this podcast we dive deep into the healthcare space, from the people that dedicate their lives to patient care to the companies improving patient outcomes through innovation. From well-respected surgeons and thought leaders to those on the front lines of healthcare, we’ll bring you conversations with those making a difference both in the OR and beyond. Through in-depth interviews with nurses, sterile processing technicians, clinical managers, and even healthcare technology companies and startups, we’ll discuss what’s on the horizon in the industry in regards to careers, technology, and innovation.