Intraoperative neuromonitoring (IONM) is used for reducing the risk of neurological damage during and after a surgery involving the nervous system. IONM has witnessed remarkable growth in the last decade owing to the technological advancements in the devices used for the procedures. IONM assists surgeons to monitor neural pathways while performing high risk peripheral nerve, neurological, orthopedic and vascular surgeries. With the assistance of IONM, surgeons can detect injuries before they become severe causing neurological deficits after the surgery. This has largely reduced the risk of debilitating deficits such as hearing loss, paralysis, muscle weakness and loss of other normal bodily functions. IONM is primarily used for diagnostic support during surgeries such as those involving peripheral nerves. IONM guides the surgeon in identifying critical neural structures thus reducing the likelihood of postoperative impairments.
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IONM includes different modalities meant for specific applications, with several modalities often used together in same surgeries. These modalities are somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), electroencephalography (EEG), brainstem auditory evoked potentials (BAEPs), electromyography and visual evoked potentials (VEPs). EEG records electrical activity from the scalp. It is widely used for assessing the degree of hypothermia for neuro-protection and the monitoring extent of cerebral perfusion during critical vascular surgeries. Electromyography (EMG) records electrical activity induced by skeletal muscles. Some of the fundamental techniques of EMG include stimulated EMG, free running EMG and intraoperative nerve conduction studies (NCS). Visual evoked potentials (VEPs) refer to electrical potentials induced through brief visual stimuli. IONM of the visual pathway is critical in different types of surgeries such as transsphenoidal surgery and operations involving removal of tumors near the optic radiation. Brainstem auditory evoked potentials (BAEPs) are the electrical potentials generated as a response to acoustic stimuli. These potentials are useful in order to monitor auditory structures.
The key factor driving the Intraoperative neuromonitoring market growth is increased emphasis on safety of the patients during high-risk, complicated surgeries. Also, due to increased prevalence of chronic diseases and geriatric population, there has been a rise in complex surgeries requiring sophisticated monitoring techniques. These factors will significantly contribute to the growth of the IONM market in coming years. However restraints such as low awareness regarding IONM in developing economies and scarcity of skilled professionals to operate complex IONM devices can hinder the growth of the global IONM market.
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With development in Intraoperative neuromonitoring techniques such as advanced pedicle screw stimulation techniques to avoid complications associated with misplacement of the a pedicle screw(s) which could result in vascular and neural complications, the market will witness more sophisticated devices and procedures being introduced in coming years. The key players operating in the IONM market focus on strategic mergers and acquisitions in order to gain a competitive edge over other players. For instance, in June 2016, Biotronic NeuroNetwork acquired NuWave Monitoring, LLC, an intraoperative neuromonitoring company. The acquisition was intended for strengthening Biotronic’s presence in Chicago and northwestern Indiana. Similarly in June 2016, SpecialtyCare, a provider of outsourced IONM and surgical services acquired Sentient Medical Systems in order to increase its coverage throughout the Atlantic states. Some of the key players in the IONM market are, SpecialtyCare, NuVasive Inc., Medtronic plc, Natus Medical Incorporated, Neuromonitoring Technologies, Inc., Computational Diagnostics, Inc., IntraNerve, LLC, Moberg Research, Inc. and inomed Medizintechnik GmbH.
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