Monitoring devices without professionals of intraoperative neurophysiological monitoring: is it trustworthy?

Abstract

The more world-widely performed intraoperative neurophysiological monitoring (IONM) aims at early detection of damage to the nervous system during surgery in the ultimate purpose of minimizing the risk of postoperative neurologic deteriorations. As some major consensus has been drawn from the accumulated research on the criteria for alarm sign, based on the expectation for the automated, surgeon-directed neuro-monitoring system, a device was developed that automatically monitor electromyography and motor evoked potentials and makes the sound or visual alarm after detecting the change of nervous response. However, for the precise, real-time interpretation of the IONM, a comprehensive consideration of the patient's factors and environmental factors occurring during the surgery is needed as well as an abundant experience of electrodiagnostic evaluation. Therefore, IONM practitioners should be a professional physiatrist or neurologist who does not participate directly in the surgery but sorely participate in IONM continuously. Further, there are clinical limitations in using and interpreting the waves obtained by automated equipment directly by the surgeon who is fully concentrated on the operation. As conclusion, the automated, surgeon-directed neuro-monitoring equipment cannot substitute for the role of the IONM professionals.