Back Module: S-NI-S4

Performing Intraoperative Neuromonitoring

Module information

Module details

Title
Performing Intraoperative Neuromonitoring
Type
Specialist
Module code
S-NI-S4
Credits
10
Phase
3
Requirement
Compulsory

Aim of this module

This module aims to provide trainees with experience of performing intraoperative neuromonitoring for spinal surgery using multi-modality monitoring techniques.

Work-based content

Training activities

# Learning outcome Training activity Type Action
# 1 Learning outcome 1, 7 Training activities

Participate in theatre briefing/huddles, discuss, and confirm intraoperative neuromonitoring plans for spinal surgery, documenting any adaptations to the plans following discussion with surgeon and/or anaesthetist.

 Type ETA Action View
# 2 Learning outcome 1, 4, 7 Training activities

Correctly position intraoperative neuromonitoring system(s) used for spinal surgeries in theatre, including correct and safe positioning of cables, amplifiers, stimulators, and other ancillary equipment.

 Type ETA Action View
# 3 Learning outcome 1, 2, 3 Training activities

Prepare patients undergoing spinal surgery in readiness to record the following intraoperative neuromonitoring modalities:

 

  • Lower limb somatosensory evoked potentials
  • Upper limb somatosensory evoked potentials
  • Lower limb motor evoked potentials
  • Upper limb motor evoked potentials
  • Upper limb free-run electromyography
  • Lower limb free-run electromyography
 Type ETA Action View
# 4 Learning outcome 1, 4 Training activities

Complete pre-monitoring checks on the intraoperative neuromonitoring system (machine) used for spinal surgery and remedy any faults found.

 Type ETA Action View
# 5 Learning outcome 1, 2, 3, 7 Training activities

Obtain, report, document and feedback baselines for the modalities being monitored in spinal surgery. To include:

 

  • Lower limb somatosensory evoked potentials
  • Upper limb somatosensory evoked potentials
  • Lower limb motor evoked potentials
  • Upper limb motor evoked potentials
  • Upper limb free-run electromyography
  • Lower limb free-run electromyography
 Type ETA Action View
# 6 Learning outcome 1, 4 Training activities

Optimise recorded responses throughout intraoperative neuromonitoring for spinal surgery. To include:

 

  • Lower limb somatosensory evoked potentials
  • Upper limb somatosensory evoked potentials
  • Lower limb motor evoked potentials
  • Upper limb motor evoked potentials
  • Upper limb free-run electromyography
  • Lower limb free-run electromyography
 Type ETA Action View
# 7 Learning outcome 1, 4, 5,7 Training activities

Regularly monitor and interpret recorded responses throughout surgical procedures for spinal, to include:

  • communicating with the theatre team
  • identifying and responding to factors impacting responses
  • documenting any relevant pathogenic, non-pathogenic, and neurophysiological changes when required.

For both:

  • Lower limb somatosensory evoked potentials
  • Upper limb somatosensory evoked potentials

 

 Type ETA Action View
# 8 Learning outcome 1, 4, 5, 7 Training activities

Regularly monitor and interpret recorded responses throughout surgical procedures for spinal, to include:

  • communicating with the theatre team,
  • identifying and responding to factors impacting responses
  • documenting any relevant pathogenic, non-pathogenic, and neurophysiological changes when required.

For both:

  • Lower limb motor evoked potentials
  • Upper limb motor evoked potentials
 Type ETA Action View
# 9 Learning outcome 1, 3, 4, 5, 7 Training activities

Monitor and interpret recorded responses throughout surgical procedures for spinal, to include:

  • communicating with the theatre team,
  • identifying and responding to factors impacting responses
  • documenting any relevant pathogenic, non-pathogenic, and neurophysiological changes when required.

For at least one the following:

  • Triggered electromyography
  • Free-running electromyography
 Type DTA Action View
# 10 Learning outcome 1, 4, 6, Training activities

Complete actions to conclude in-theatre intraoperative neuromonitoring for spinal surgeries, to include:

 

  • Safely removing and disposing of equipment including electrodes
  • Decontaminating equipment
  • Ensuring data is safely saved
 Type ETA Action View

Assessments

Complete 2 Case-Based Discussions

Complete 2 DOPS or OCEs

Direct Observation of Practical Skills Titles

  • Set up the intraoperative neuromonitoring equipment for spinal surgery in theatre according to the case requiring monitoring.
  • Apply electrodes for the recording of intraoperative upper and/ or lower limb somatosensory or motor evoked potentials for spinal surgery.
  • Record and establish baselines for upper or lower limb somatosensory or motor evoked potentials for spinal surgery.

Observed Communication Event Titles

  • Confirm details required to perform effective IONM with the theatre team
  • Discuss risks and benefits of the monitoring approach at the theatre briefing/huddle

Learning outcomes

# Learning outcome
1

Follow the pre-operative plan for intraoperative neuromonitoring for spinal surgery, making any necessary adjustments based on information available on the day of monitoring.
2

Set pre-operative baseline recordings for intraoperative neuromonitoring for spinal surgery.
3

Record free running and/or triggered electromyography during intraoperative neuromonitoring for spinal surgery.
4

Identify and respond to factors that impact intraoperative neuromonitoring for spinal surgery including technical problems and physiological effects.
5

Identify, communicate and document relevant changes noted in intraoperative neuromonitoring for spinal surgery.
6

Complete actions to conclude in-theatre intraoperative neuromonitoring for spinal surgery.
7

Demonstrate effective and professional communication skills with the multidisciplinary theatre team.

Clinical experiences

Clinical experiences help you to develop insight into your practice and a greater understanding of your specialty's impact on patient care. Clinical experiences should be included in your training plan and you may be asked to help organise your experiences. Reflections and observations from your experiences may help you to advance your practice and can be used to develop evidence to demonstrate your awareness and appreciation of your specialty.

Activities

  • Observe a neurosurgical outpatient clinic where patients are assessed for neurosurgical intervention for spinal surgeries.
  • Observe complex IONM monitoring/mapping for supratentorial surgery for example motor mapping, sensory mapping, EEG monitoring.
  • Observe complex IONM monitoring/mapping for infratentorial surgery for example brainstem auditory evoked potentials, cranial nerve monitoring, cranial nerve mapping.
  • Observe peripheral nerve injury surgery for example brachial plexus.

Academic content (MSc in Clinical Science)

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning outcomes

  1. Apply integrative understanding of spinal cord and vertebral column surgical procedures and potential iatrogenic complications.
  2. Critically evaluate the uses of evoked potentials and EMG during spinal surgery
  3. Apply integrative understanding in the requirements for the recording of high-quality signals during IONM.
  4. Demonstrate understanding of artefacts, anaesthetic, and systemic effects in IONM signals.
  5. Critically analyse the evidence on IONM for identifying, preventing and/or reducing neurological damage.

Indicative content

  • Adapting monitoring/mapping plan to surgery needs.
  • Spinal cord and nerve root mapping.
  • Importance of baseline recording. Signal morphology and amplitude. Fluctuations and reproducibility.
  • Troubleshooting recording artifacts and stimulation problems.
  • IONM signals optimisation.
  • Common surgical steps and mechanisms that may cause IONM signal changes. Patterns and timing of changes.
  • Identifying non-pathological sources of changes in EPs and EMG.
  • Use of alarm criteria
  • Risks while performing IONM, and prevention of IONM complications and injuries.
  • Relevant information to document during the signals acquisition: role of annotations and comments
  • Importance of accurate and timely communication with the surgical team.

Module assigned to

Specialties

Specialty code Specialty title Action
Specialty code SPS2-3-25 Specialty title Neurophysiology: Intraoperative Neuromonitoring [2025] Action View
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