IONM Service


TNAI utilizes real time IONM data transmission and multiple modalities (SSEP, TCeMEP, EEG, EMG, BAER) to monitor motor pathways, sensory pathways, and brain activity during traditional spine, minimally invasive spine, hip, and cardiovascular/cardiothoracic surgical procedures. TNAI also has experience monitoring pain management procedures in which the spinal cord and nerve roots are susceptible to damage.


Orthopedic Surgery

Cardiovascular / Cardiothoracic Surgery

Otolaryngologic Surgery


To put it simply, TNAI monitoring provides better patient outcomes. IONM provides invaluable real time neurological feedback when neural structures are at risk. IONM is the standard of care during procedures with a high incidence of neural compromise.

Anesthesia Recommendations

Every surgery is different, and we tailor our IONM protocol according to physicians’ decisions regarding anesthesia. Choice of anesthesia alters the IONM procedures that can be performed. Anesthesia considerations are as follows:


Inhaled anesthetics interfere with SSEP and MEP acquisition due to their inhibitory action on electrical impulses across the synapse. To ensure accurate acquisition of data, we ask that, if the patient is to be sedated, the patient be adequately sedated prior to the time of recording and that inhaled anesthetic agents are avoided during the procedure if the physician desires SSEP and MEP analysis.


If TIVA is not prescribed by physicians, less than ½ MAC Sevoflurane combined with a short acting paralytic will dramatically improve results. This combination should allow for accurate data acquisition. Nitrous Oxide enhances effects of other inhaled anesthesia agents which could interfere with the data collection.

What to Expect

After receiving the referral, our administrative team with verify the patient’s benefits and add them to our schedule given by your facility.

On the day of the procedure, a TNAI technician will arrive approximately one hour prior to the procedure and set up equipment and link with the supervising neurologist.

A TNAI technician performs a pre-operative assessment of gross motor function, documents pre-existing conditions, and determines whether contraindications for IONM such as a history of seizures and the presence of cardiac/cranial implants exist.

During the procedure, a TNAI technician executes various modalities and transmits the data in real time to an interpreting neurologist who provides appropriate real-time clinical recommendations.

TNAI technicians perform a series of post-operative neurological evaluations to help physicians begin assessing long-term post-operative outcomes.

A post-operative report written and signed by the supervising neurologist will be sent to your office if desired.

All billing is performed under the direction of TNAI.