The Evolution of Real-time Remote Intraoperative Neurophysiological Monitoring (IONM)

TL;DR

This paper reviews the development and current state of real-time remote intraoperative neurophysiological monitoring (IONM), highlighting technological advances, widespread adoption, and key features like security, data archival, and remote control.

Contribution

It provides a comprehensive overview of the evolution, technological infrastructure, and clinical adoption of remote IONM over time.

Findings

Remote IONM is used in over 200,000 high-risk surgeries annually in the US.

Technological improvements include enhanced security, data archival, and remote control features.

Remote IONM has become a standard practice in neurosurgical procedures.

Abstract

Real-time monitoring of nervous system function with immediate communication of relevant information to the surgeon enables prevention and/or mitigation of iatrogenic injury in many surgical procedures. The hardware and software infrastructure and demonstrated usefulness of telemedicine in support of IONM originated in a busy university health center environment and then spread widely as comparable functional capabilities were added by commercial equipment manufacturers. The earliest implementations included primitive data archival and case documentation capabilities and relied primarily on deidentification for security. They emphasized full-featured control of the real-time data display by remote observers. Today, remote IONM is routinely utilized in more than 200,000 high-risk surgical procedures/year in the United States. For many cases, remote observers rely on screen capture to view the data as it is displayed in the remote operating room while providing sophisticated security capabilities and data archival and standardized metadata and case documentation.