Spinal Cord Stimulation: Neuromodulation for Intraoperative Neuromonitoring Personnel

Intraoperative neuromonitoring (IONM) has emerged as a transformative tool in spinal cord stimulation (SCS) and dorsal root ganglion (DRG) procedures, enabling precise lead placement under general anesthesia. It also addresses the safety aspect of placement in an asleep patient while also mitigating the challenges of traditional awake techniques. This paper outlines the protocols and benefits of IONM, with a focus on electromyography (EMG) and somatosensory evoked potentials (SSEP) for real-time guidance during thoracic, cervical, and DRG stimulator placement. It explores how IONM optimizes myotomal-to-dermatomal mapping, improves paresthesia coverage, and enhances outcomes by reducing revision rates. Additionally, the paper evaluates waveform-specific neuromodulation effects, highlighting advancements in personalized pain management through innovative stimulation paradigms and potential mechanisms of action.