Intraoperative neurophysiologic monitoring (IONM) is a patient protective service provided during surgery to directly and immediately deliver feedback to the surgeon and anesthesiologist on the functional status of the nervous system. IONM is a branch of neurodiagnostics that, like other practices in the discipline, takes advantage of the electrical properties of nerves and muscles to evaluate and track the function of the nervous system. The purpose of IONM is the timely delivery of data to allow for implementation of specific corrective actions before any change in neurologic function, iatrogenic or otherwise, becomes long-lasting or permanent. IONM is a specialized field and requires that the person who provides the service in the operating room, the surgical neurophysiologist, complete specific IONM education and training. Chiropractors are uniquely suited for the role of surgical neurophysiologist – they are medically trained with particular emphasis on neurology, they have in depth and first-hand experience helping patients achieve their medical objectives effectively, they are very patient centric often with exemplary bed-side manner, etc. Furthermore, participating in IONM does not preclude a chiropractor from continuing their practice since working in the operating room to deliver IONM can be coordinated with her/his patient care schedule in the chiropractic clinic.
The course provides a general understanding of IONM, what it’s intended for and what it is capable of. To help the student understand the practicalities of IONM, we describe the common service delivery models and standard practices therein. In the course, we explore a selection of the common neurophysiologic tests performed in IONM including Somatosensory Evoked Potentials (SSEPs), free running - and stimulus evoked - electromyography (EMG), Transcranial electric Motor Evoked Potentials (TCeMEP), Electroencephalography (EEG), Brainstem Auditory Evoked Responses (BAER) and brain mapping. Furthermore, we demonstrate the application and interpretation of these modalities through case studies. The course concludes with a discussion of the specific considerations for chiropractors who are considering the field of IONM. This course is applicable to chiropractors at any career stage and qualifies for 6 continuing education credits.