Dr. Zeeshan Sardar, MD, MSc, F.R.C.S.C
Director Quality & Patient Safety (QPS) – Och Spine Hospital
Medical Director, Spine Unit – Och Spine Hospital
Co-Chief of Spinal Deformity Surgery • NewYork-Presbyterian / Columbia University
Och Spine Hospital • New York, NY
Intraoperative neuromonitoring (IONM) is a real-time safeguard used during spine surgery to track the health of the spinal cord and nerve roots while the operation is underway. For procedures that involve significant deformity correction, decompression near the spinal cord, or instrumentation close to neural structures, IONM gives the surgical team continuous feedback that helps prevent neurological injury before it happens.
Dr. Sardar uses IONM as a standard part of complex spinal deformity, revision, and decompression surgery, working alongside a dedicated neuromonitoring team throughout every case.
WHAT IS INTRAOPERATIVE NEUROMONITORING?
IONM is the continuous electrophysiological monitoring of the spinal cord, nerve roots, and surrounding neural structures during surgery. Electrodes placed on the skin or scalp allow a neurophysiologist to track the electrical signals traveling through the nervous system in real time — essentially listening for any change that might signal the nervous system is under stress.
Because the spinal cord cannot be directly visualized once instrumentation is in place, and because a patient is under anesthesia and cannot report symptoms during the procedure, IONM serves as the surgical team’s real-time window into neurological function throughout the case.
WHY IT MATTERS
Spinal deformity correction, osteotomy procedures, and decompression near the spinal cord all carry a risk of neurological injury. IONM allows the surgical team to detect early warning signs of compromised neural function and to respond immediately by adjusting the correction, repositioning instrumentation, increasing blood pressure, or pausing the procedure until signals normalize.
This real-time feedback loop is one of the most important safety advances in modern spinal deformity and complex spine surgery, and it is why Dr. Sardar uses it as standard practice in any case where the spinal cord or nerve roots are at meaningful risk.
HOW IONM WORKS
Somatosensory Evoked Potentials (SSEP)
SSEP monitoring involves stimulating peripheral nerves — typically at the wrist or ankle — and recording the resulting electrical signal as it travels up the spinal cord to the brain. A delay or drop in signal can indicate that the sensory pathways of the spinal cord are being affected by the surgery.
Motor Evoked Potentials (MEP)
MEP monitoring stimulates the motor cortex of the brain and records the resulting muscle response in the limbs. Because MEPs specifically track the motor pathways of the spinal cord, they are considered one of the most sensitive indicators of impending injury to the corticospinal tract during deformity correction.
Electromyography (EMG)
EMG monitoring tracks the electrical activity of specific muscles to detect irritation or compression of individual nerve roots, which is particularly useful during pedicle screw placement and decompression procedures to confirm that instrumentation is not impinging on a nerve root.
WHEN IS IONM USED?
Dr. Sardar uses IONM in any procedure where the spinal cord or nerve roots are at risk, including:
- Spinal deformity correction — scoliosis, kyphosis, and adult spinal deformity surgery
- Osteotomy procedures — pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR)
- Revision and complex reconstruction surgery, including Harrington rod revision
- Decompression for cervical stenosis, particularly with pre-existing cord compression or myelopathy
- Tumor resection or other procedures requiring extensive work near the spinal cord
WHAT HAPPENS IF A CHANGE IS DETECTED?
If the neuromonitoring team identifies a significant change in signal, Dr. Sardar is notified immediately. Depending on the situation, the response may include releasing surgical correction, repositioning or removing instrumentation, raising the patient’s blood pressure to improve spinal cord perfusion, or pausing the procedure entirely until signals return toward baseline. In the large majority of cases, signal changes detected this way are reversible once the underlying cause is addressed — which is the entire purpose of monitoring continuously rather than only checking neurological function after the fact.
FREQUENTLY ASKED QUESTIONS
Is intraoperative neuromonitoring required for every spine surgery?
No. IONM is used selectively, in procedures where the spinal cord or nerve roots are at risk — such as deformity correction, osteotomy, revision surgery, or pre-existing cord compression. Many routine, lower-risk procedures do not require it.
Does IONM add risk or time to the surgery?
IONM itself does not add meaningful risk. It does require coordination with anesthesia, since certain anesthetic agents can interfere with signal quality, and a dedicated neurophysiologist monitors signals throughout the case as part of the surgical team.
Can IONM completely prevent neurological injury?
No monitoring technology can guarantee a complication-free outcome, but IONM significantly improves the surgical team’s ability to detect a problem early and intervene. It is one of several layers of safety used together — alongside careful surgical technique, imaging, and robotic navigation where appropriate.
Will I feel anything from the monitoring electrodes?
No. IONM is performed entirely while you are under general anesthesia. The electrodes are placed before you go to sleep and removed before you wake up, so there is no sensation associated with the monitoring itself.
WHY CHOOSE DR. SARDAR
Dr. Sardar incorporates intraoperative neuromonitoring as a standard part of his approach to complex spinal deformity, revision, and decompression surgery — working in close coordination with a dedicated neuromonitoring team and anesthesiology throughout every case where neural structures are at risk.
As Co-Chief of Spinal Deformity Surgery and Director of Quality & Patient Safety at the Och Spine Hospital at NewYork-Presbyterian, patient safety infrastructure — including neuromonitoring, robotic navigation, and intraoperative imaging — is central to how his program approaches every case.
Patients travel from across the United States and internationally to see Dr. Sardar. Telemedicine consultations are available for patients in NY, NJ, CT, FL, PA, MO, CA, and TX. International patients can contact NewYork-Presbyterian Global Services at +1-212-746-9100.
This page is for educational purposes only and does not constitute individualized medical advice. Please consult a qualified spine specialist to discuss your specific condition and treatment options.
REQUEST A CONSULTATION
To schedule a consultation with Dr. Sardar, call 212-932-5187 or use the contact form below.
RELATED CONDITIONS & PROCEDURES
- Spinal Deformity — overview of the deformity conditions Dr. Sardar treats
- Cervical Myelopathy — spinal cord compression in the neck, where IONM is frequently used
- Robotic Spine Surgery — another core safety and precision technology used in Dr. Sardar’s practice
- Revision Spine Surgery — complex reconstruction where neuromonitoring is standard practice