Correcting spinal deformities requires surgeons to work within millimeters of the spinal cord and delicate nerve structures. Any misstep can lead to neurological complications that affect movement, sensation or quality of life. To reduce these risks, Intraoperative Neuromonitoring (IONM) has become a vital part of deformity surgery. Dr. Larry Davidson, a renowned neurosurgeon specializing in spinal care, has been a leading advocate for IONM, using real-time nerve monitoring to protect patients during complex procedures. His work reflects the growing emphasis on patient safety and precision in spinal surgery.
Why Neuromonitoring Matters
Spinal deformity correction often involves placing screws, rods and grafts near sensitive neural tissue. While imaging and navigation guide placement, they cannot always predict how the spinal cord and nerves respond to mechanical changes during surgery. Compression, stretching or accidental contact can cause permanent damage, if not detected immediately.
IONM addresses this challenge by providing real-time feedback about nerve function during the procedure. By continuously monitoring the electrical activity of the spinal cord and peripheral nerves, surgical teams gain early warning signs of potential injury. It allows for immediate adjustments, reducing the risk of lasting complications. Neuromonitoring is not a safeguard used in isolation, but part of an integrated safety strategy that includes precise planning, advanced imaging and careful technique.
How IONM Works
Intraoperative neuromonitoring uses electrodes placed on the scalp, spine or limbs to measure electrical activity. Signals are generated either by stimulating nerves or recording spontaneous activity. These signals are then displayed on monitors in real time, allowing the surgical team to track changes throughout the procedure.
The most common techniques include Somatosensory Evoked Potentials (SSEPs), which assess the sensory pathways, and Motor Evoked Potentials (MEPs), which test motor function. They provide a comprehensive view of how the spinal cord and nerves respond to surgery. If changes in signals are detected, such as reduced amplitude or delayed responses, the team can act immediately. It may involve repositioning hardware, reducing correction forces or modifying the surgical approach to relieve stress on neural structures. This real-time information is invaluable, turning potential complications into manageable adjustments, before permanent damage occurs.
Integration Into Deformity Correction
IONM is particularly important in deformity correction, where substantial spinal realignment takes place. Straightening or balancing the spine can place stress on the cord and nerves, even when hardware is placed accurately. Monitoring helps guide corrections within safe limits, protecting neurological function, while achieving proper alignment.
In procedures involving severe scoliosis or kyphosis, where the spinal cord may already be under strain, IONM becomes even more critical. It helps surgeons balance the goals of correction with the need to preserve neurological safety. Dr. Larry Davidson uses neuromonitoring in his deformity surgeries, demonstrating how IONM provides the guidance needed to pursue ambitious corrections, while protecting patients’ mobility and independence.
The Team Approach to Monitoring
Successful IONM depends on collaboration among surgeons, anesthesiologists and specialized neurophysiologists. Anesthetics must be carefully managed to avoid interfering with nerve signals, while neurophysiologists interpret the data and alert the team to any concerning changes. This multidisciplinary approach provides the surgeon with accurate, real-time information that can be acted upon immediately. Clear communication among team members is essential, as a rapid response often determines whether a potential complication is avoided.
Benefits for Patients
The value of IONM lies in peace of mind and protection. By reducing the risk of paralysis, weakness or sensory loss, neuromonitoring makes deformity surgery safer. It also supports more confident surgical planning, as surgeons can pursue necessary corrections, knowing that nerve function is being continuously assessed.
Dr. Larry Davidson explains, “Every movement we make during spinal cord surgery can affect a patient’s future independence. Monitoring nerve function allows us to correct deformities, while protecting their ability to walk, feel and move.” His perspective highlights that neuromonitoring is not only a technical tool but also a deeply human safeguard, giving patients the best chance for independence and recovery. IONM also supports better long-term outcomes. Patients who undergo monitored surgeries are less likely to need revisions for nerve-related complications, and often report greater confidence during rehabilitation. In deformity correction, the goal is not just alignment, but preserving the ability to live independently, and neuromonitoring plays a central role in achieving this balance.
Athletes and Neurological Protection
Athletes with spinal deformities face heightened concerns about nerve protection, as mobility and coordination are essential to their performance. For these patients, IONM provides reassurance that surgery can correct deformities, without jeopardizing their athletic potential.
By detecting even subtle changes in nerve function, IONM allows surgeons to make adjustments, while maintaining neurological safety. For athletic patients, protecting neural integrity is just as important as achieving structural correction. IONM acts as both a safeguard and a guide, helping athletes pursue rehabilitation, and return to activity with greater confidence.
Training and Education in Neuromonitoring
As IONM becomes standard in spinal deformity correction, surgical training programs now emphasize its principles and applications. Surgeons learn to interpret monitoring data, collaborate closely with neurophysiologists and integrate real-time feedback into their surgical decisions. Dr. Larry Davidson teaches these principles to younger surgeons, highlighting that neuromonitoring is not a substitute for surgical skill, but a complement that enhances both safety and confidence.
Patients as Partners in Understanding IONM
Patients often have questions about what neuromonitoring involves and how it benefits them. Clear communication about the process helps reduce anxiety and builds trust. By explaining that electrodes monitor nerve function and that alerts allow for immediate action, surgeons can reassure patients that multiple safeguards are in place. Educating patients helps those undergoing deformity correction understand how IONM protects them. This transparency supports shared decision-making and builds confidence in the surgical plan. The future of neuromonitoring may include even more refined techniques, such as high-resolution spinal cord mapping and integration with robotics. Advances in signal analysis and machine learning could allow earlier detection of nerve stress, further reducing risks.
Intraoperative neuromonitoring has become an essential component of spinal deformity correction, providing real-time protection for delicate neural structures. By detecting changes in nerve function, IONM allows surgeons to adjust techniques and prevent complications that could impact mobility or independence. Dr. Larry Davidson advocates for neuromonitoring as part of a commitment to precision and patient-centered care. Its use helps deformity correction achieve proper alignment, while preserving neurological health, giving patients the best chance for a safe and effective recovery.
