Intra-Operative Electromyography

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What is Intraoperative Neurophysiological Monitoring (IONM)? 

If you are facing a brain or spine surgery, your safety and well-being are our top priorities. That’s why our surgical team uses advanced neurophysiological monitoring techniques to provide an extra layer of protection during your procedure.

We often urge patients to think of intraoperative neurophysiological monitoring (IONM) as a sophisticated “safety alert system” that watches over your nervous system throughout your surgery. With IONM, we can continuously monitor the health of your brain, spinal cord, and critical nerves in real-time. If that monitoring reveals that something may be amiss, we can act quickly to ensure safety and prevent nerve damage from occurring. 

We utilize three main neurophysiological monitoring techniques at our practice:

• Intraoperative electromyography (EMG)
• Intraoperative electrocorticography (ECoG)
• Evoked Potentials
  • Sensory Evoked potentials
  • Motor Evoked potentials 
  • Brainstem Auditory Evoked Responses
  • Visual Evoked Responses
  • Facial Evoked Motor Potentials

IONM is an integral part of our approach to patient care. When surgeries involve delicate work near your brain, spine, or critical nerves (as many of our procedures do) these monitoring techniques help us maintain the highest safety standards. 

Understanding the three key IONM techniques: electromyography (EMG), electrocorticography, and evoked potentials 

Intraoperative electromyography (EMG): Monitoring nerve-to-muscle connections 

• When we use EMG: We typically employ this technique during spine surgeries, brain and skull base surgeries, and head and neck surgeries. 
• How it works for you: While you’re under anesthesia, we apply small electrodes to specific muscles. These electrodes then pick up electrical signals from the muscles. If a nerve becomes irritated during surgery, the electrodes alert your surgical team, allowing us to adjust our approach before any damage occurs. Intraoperative EMG can be either spontaneous (monitoring irritation in real time) or triggered (stimulating a nerve to confirm function).

Intraoperative electrocorticography (ECoG): Monitoring brain activity 

• When we use ECoG:  This technique is primarily used during brain surgeries, particularly for treating epilepsy or removing brain tumors and occasionally for mapping functional areas before resection.
• How it works for you: We place small electrode strips directly on the surface of your brain to monitor its electrical activity in real-time. This allows us to detect any abnormal patterns, such as seizure activity, and helps us clearly distinguish between healthy brain tissue and areas that may need treatment.

Evoked potentials: Monitoring movement 

• When we use Motor Evoked Potentials (MEPs): We typically use this monitoring during spinal surgeries and certain brain or brainstem procedures.
• How it works for you: We deliver small electrical signals to your brain, which travel down your spinal cord to your muscles. This enables us to continually assess whether these signals are reaching their destination successfully.
• What this means: MEPs help us ensure that your ability to move, walk, and maintain strength remains protected throughout your surgery. If any signals show changes, we make immediate adjustments.

Your safety is our priority: IONM at New Jersey Brain and Spine

At New Jersey Brain and Spine, IONM represents our commitment to your safety and optimal outcomes. This advanced monitoring significantly reduces the risk of complications such as paralysis, numbness, or weakness.

We may discuss IONM with you if you’re having:

• Spinal fusion or other spine surgeries
• Surgeries near critical nerves in your neck or other areas
• Brain tumor removal
• Procedures involving epilepsy treatment
• Any surgery where nerve function could be at risk

IONM is one of the many ways we demonstrate our commitment to providing you with the safest care possible. If you have any questions about IONM or how it applies to your procedure, please don’t hesitate to ask. We’re here to ensure you feel informed and confident in your care at every step.