Communication and collaboration in spine neuromonitoring: time to expect more, a lot more, from the neurophysiologists

T his commentary is addressed to surgeons who order intraoperative neuromonitoring (IONM). In the US, and in some other countries, a certified technologist is commonly supervised by an expert neurophysiologist physician. US neurophysiologist physicians are often positioned off-site while monitoring several or many cases simultaneously. As an example of a contrary view that is also held elsewhere in the world, a leading Canadian authority argues, "The vast majority of those involved in IONM in Canada believe, for best practice, the IONM expert should be in the operating room (OR) doing the neurophysiology" (personal communication, David Houlden, University of Ottawa, 2016).