Intraoperative Neurophysiological Monitoring (IONM): New Grounds for Malpractice Liability
In the operating room, split-second decisions can determine whether a patient wakes up healthy or suffers permanent disability. One tool that has become increasingly critical is Intraoperative Neurophysiological Monitoring (IONM)—the real-time tracking of nerve and spinal cord function during surgery.
When properly used, IONM helps surgeons avoid catastrophic injuries such as paralysis, vocal cord damage, or hearing loss. But when it is misused, misinterpreted, or ignored, the results can be devastating—and malpractice claims are on the rise.
At Lexcura Summit Medical-Legal Consulting, we help attorneys navigate this emerging frontier of litigation with medical chronologies, narrative summaries, and expert reviews that pinpoint where protocols broke down.
🧠 What Is Intraoperative Neurophysiological Monitoring (IONM)?
IONM uses electrical signals to assess the function of nerves and the spinal cord during procedures such as:
Spinal fusions and deformity corrections
Neurosurgical tumor resections
ENT and thyroid surgeries
Vascular procedures near the brain or spine
Specialized technologists and physicians interpret these signals and alert the surgical team to potential compromise. When the system works, it can prevent irreversible harm.
⚠️ Where Liability Arises
Despite its importance, IONM introduces new opportunities for error:
Failure to Use IONM
In cases where standard of care requires monitoring, not using IONM at all may be negligence.
Example: A spinal deformity correction without monitoring leads to paralysis.
Misinterpretation of Signals
IONM is only as good as the technologist and supervising physician interpreting the data.
Courts have seen claims where technologists failed to warn the surgeon of significant changes in waveforms.
Communication Failures
Even if signals are detected, delays in alerting the surgeon can make the difference between recovery and permanent harm.
Non-Compliance with Guidelines
Professional societies such as ASNM (American Society of Neurophysiological Monitoring) issue practice standards.
Deviations from these protocols often become a focal point of litigation.
⚖️ Case Law Examples
Recent malpractice cases have highlighted IONM failures:
Spinal Surgery Paralysis Case – Plaintiffs alleged that monitoring data clearly showed signal loss, but the surgeon was not informed in time. The court allowed the claim to proceed, citing the technologist’s duty of care.
ENT Nerve Damage Case – A patient sustained permanent vocal cord injury after thyroid surgery. Expert testimony showed IONM was either improperly applied or ignored, creating grounds for negligence.
Failure to Supervise – Some lawsuits target hospitals and supervising neurologists who failed to ensure qualified technologists were interpreting data in real time.
These cases illustrate that liability may extend beyond the surgeon—to hospitals, monitoring companies, and even off-site neurologists.
📚 Implications for Plaintiffs and Defense
For Plaintiffs: IONM records can be a goldmine. Waveform data, logs, and communication transcripts often reveal whether monitoring was performed correctly.
For Defense: Strong rebuttals require showing compliance with guidelines, alternative causes for the outcome, or limits of monitoring technology.
🧾 How Lexcura Summit Supports IONM Cases
At Lexcura Summit, our team helps attorneys build stronger IONM cases by providing:
Medical Chronologies – reconstructing intraoperative timelines minute-by-minute.
Expert Record Review – analyzing IONM data, operative reports, and guidelines compliance.
Rebuttal & Defense Reports – challenging unsupported claims of negligence.
Life Care Plans – documenting long-term costs when injuries lead to permanent disability.
With 7-day standard turnaround (2–3 day rush available), HIPAA-compliant systems, and nationwide expertise, we help attorneys pursue—or defend—these complex claims with confidence.
✅ Key Takeaways
IONM is becoming standard of care in many high-risk surgeries.
Liability arises from non-use, misinterpretation, or delayed communication of monitoring data.
Recent case law confirms that negligence may extend beyond the surgeon to hospitals and monitoring providers.
Lexcura Summit provides litigation-ready support, helping attorneys use IONM data strategically in malpractice cases.
📞 Contact Lexcura Summit
Strengthen your malpractice litigation with expert medical-legal consulting.
📖 Ask about our complimentary 250-page case review today.
Lexcura Summit Medical-Legal Consulting, LLC
📞 (352) 703-0703
🌐 www.lexcura-summit.com
