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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