Broca's Area: communication and collaboration in spine neuromonitoring: time to expect more, a lot more, from the neurophysiologists

This 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. 40 US neurophysiologist physicians are often po - sitioned off-site while monitoring several or many cases simultaneously. 41 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 ex - pert should be in the operating room (OR) doing the neu - rophysiology” (personal communication, David Houlden, University of Ottawa, 2016). Similarly, the joint guidelines between the Italian Neu - rosurgical and Clinical Neurophysiology Societies clearly state that the supervising physician should be in the OR or available in-house whenever summoned to the OR. This model is quite popular in other European countries (such as Germany), but other models exist. In Spain, only clini - cal neurophysiologists are present in the OR and they per - form IONM without the support of certified technologists. Keeping these dissonant approaches in mind, we will: 1) review scholarship that indicates that improved col - laboration in the OR is associated with better patient out - comes; 2) demonstrate how IONM injury prevention is predicated on trust-based communication of test results; and 3) propose practical IONM solutions that might better achieve the trusted “expert in the OR” vision.