Resources

Hypoglossal Nerve Stimulation: A Novel Technique for IONM This isn't our first time helping surgeons map out nerves. We are starting to see some traction in hypoglossal nerve stimulation for obstructive sleep apnea. Obstructive sleep apnea is one of the most prevalent...

What Does Your IONM Resume Say About You? Let's break down the neuromonitoring field a little bit here (it will help your IONM resume not suck)... If you had to guess what percent of the cases your company monitors are spine cases, where would you place your bets? If...

Beliefs Are Identities In hindsight, it was obvious. It almost always is. But this one seems like a real head smacker. I don't need any modern equipment; 30 minutes and a playground and my 2 boys will make a bulletproof case for handwashing. Their fingernails will...

Remember a couple of years ago when we would all meet up at IONM conferences to share ideas and network in real life? Well, I'm venturing off to my first one since COVID-19 hit. This year's ASNM annual meeting is in Clearwater, Fl on May 20th and I'll be there looking...

The surgeon uses navigation and wants to know why she should use motor mapping for her crani? That's the question posed to me by a clinician years ago. It was just before I set up my case and they recruited me into the conversation. So I walked over to the room next...

How To Have A Neuromonitoring Discussion One of the reasons for starting this website was to make sure I was part of the neuromonitoring conversation. It was a decision I made early in my career... and I'm glad I did. Hearing the different perspectives and experiences...

BAER (Brainstem Auditory Evoked Potentials) During Microvascular Decompression Surgery You might remember when I was complaining about using ABR in the operating room and how to adjust the click polarity to help obtain a more reliable BAER. But my first gripe, having...

Minimally Invasive Fusion of the Sacroiliac Joint Using EMG Nerve Monitoring EMG nerve monitoring in lumbar surgery makes up a large percentage of cases monitored every year. Using EMG nerve monitoring during SI joint fusions seems to be less utilized, even though the...

SNP's Performing A Physical Exam: Who Should Do It And Who Shouldn't... Before any case is monitored, all pertinent patient history, signs, symptoms, physical exam findings and diagnostics should be gathered, documented and relayed to any oversight physician that may...

Levetiracetam And Its Effects On Transcranial Motor Evoked Potentials During Surgery Levetiracetam (AKA Keppra) It's pretty widely accepted that inhalational agents and muscle relaxants will reduce the effectiveness of transcranial motor evoked potentials during...

Double-Train MEP On A Comeback Kick Using transcranial electric motor evoked potentials in the operating room has become routine practice for spinal cord monitoring. Recent improvements in the ability to record tcMEP have resulted in increased use during other...

How Resourceful Of A Neuromonitoring Tech Are You? First off, let me start this topic off by saying that I'm not a big fan of the term neuromonitoring tech (I prefer surgical neurophysiologist or SNP). But I really want to address those in the field that might embrace...

Loss of Cortical SSEP Due To Loss of Receptor Activation Earlier in this 30 Days of Neuromonitoring series, I wrote about cortical and subcortical reorganization after a loss of afferent feedback from carpal tunnel syndrome and how that affects intraoperative...

The CNIM vs The Intraoperative Neuromonitoring Degree (Joe's notes: This is a GUEST POST by Josh Mergos, who is the director of the Intraoperative Neuromonitoring Program at the University of Michigan - School of Kinesiology. We met for the first time during a small...

Optimizing Sub-cortical SSEP There is 1 electrode that I see get misused in somatosensory evoked potentials more so than any other electrode in any modality. This is the electrode placed over the cervical spine (or sometimes around the ear or mastoid) and generally...

The Trapezius Muscle In Intraoperative Neuromonitoring If we follow the same medical textbooks we used in school to pass a test, then we know for sure that the motor portion of the trapezius is innervated by the spinal accessory nerve (CN 11) and the sensory portion...

Monitoring Train Of Four During Surgery From the perspective of the anesthesiologist, one of the benefits of having a surgical neurophysiologist monitor during surgery is a more precise measurement of muscle relaxation or train of four monitoring. In some of the...

Non-Compete Clauses In Intraoperative Neuromonitoring (Joe’s notes: In today's GUEST POST I interview Greg Barthelette, a lawyer in Boca Raton, Florida. Greg practices in a few different areas, most important to us is business law. I've used his services every time...

Carpal Tunnel Considerations In Neuromonitoring In the neurodiagnostic world, evaluating carpal tunnel syndrome is one of their bread-and-butter studies. For surgical neurophysiologist who works in the operating room, the topic of median nerve compression at the wrist...

IONM Manager: 7 Ways To Get A Neuromonitoring Management Position There are far fewer neuromonitoring management positions available than there are clinicians that want them. If you’re working for a smaller contract company or in-house neuromonitoring group, you’ll...

Propep Surgical: Pudendal Nerve Neuromonitoring During Prostatectomy (Notes from Joe: Neuromonitoring used during prostatectomies has always made sense to me, so things made sense when Jann Rasmussen from Propep surgical talked to me about his new business venture....

Is SSEP Improvement Sensitive For Detecting Complete Decompression Of The Spinal Cord Or Nerve Root? In an article that I wrote years ago, titled Brainstem Auditory Evoked Potential Used To Predict The Need For Duraplasty In Chiari Malformation Type I Decompression, I...

Steps To Becoming A Surgical Neurophysiologist (Guest Post) Joe’s Notes: I don’t really ever write it after my name anymore, but I am also an OTR (Registered Occupational Therapist). If I would have stopped there, I don't think I would have learned about becoming a...

Everyday Neuromonitoring With Anesthesia Conversations... Everyone has their own experiences working with anesthesiologist and CRNAs. At some facilities, the neuromonitoring clinician tells the anesthesia team what they need, and anesthesia accommodates. At other...

Intraoperative Bulbocavernosus Reflex Surgeon: Isn’t there anything else you can do to monitor the sacral nerve roots? That’s the area I’m most concerned about today… Me: Well, there’s the intraoperative bulbocavernosus reflex. That would monitor the pudendal nerve up...

Optimization Tip: How To Use ABR Click Polarity Wisely... Brainstem auditory evoked potentials can be a pain. Sometimes downright frustrating. Their saving grace is that anesthesia is really going to have to go out of their way to mess up the responses. We might see...

Intraoperative EEG For Depth of Anesthesia? There seems to be some confusion on the effectiveness of intraoperative EEG being able to determine some sort of depth of anesthesia. We seem to find ourselves in this scenario far too often...   "My blood pressure just...

Selective Dorsal Rhizotomy Using Intraoperative Neuromonitoring (Guest Post) (Joe's notes: This guest post, written by Kristina Young, covers one of those case types where you know you're going to be part of the surgery today. For a lot of our neuromonitoring cases,...

Saphenous SSEP For Protection Of The Femoral Nerve During Transpsoas Lateral Interbody Fusion. Not too long ago, lateral interbody fusion procedures really started to pick up in popularity. Some large studies came out that showed you could fuse the spine with less...

D-wave And Dorsal Column Mapping Training Here's the reality for people that want to get trained on doing d-wave and dorsal column mapping on spinal tumors... you most likely aren't going to have the luxury of seeing 30 of these before you start doing these yourself....

It has been a long time since I posted articles here on a regular basis. But that's all going to change here shortly. Watch the video for details.

The G0453 Code ATTENTION: This Needs To Be Handled By 9/2/2014 (EDIT: Action time is over to kill the G0453, but still worth the read) Neuromonitoring professionals have been waiting to see how Medicare’s new G code (G0453) is going to affect the way we deliver our...