The patient came to the clinic 27-October-2007 complaining of neck and right shoulder pain for 1 year after lifting heavy object. MRI cervical spine performed 14-April-2007 showed extruded disc C6-7 with left foraminal engorgement. The patient improved and deteriorated the last 3 weeks.

On examination: the patient has neck movement when looking to the left and with limitation when looking up and down ( i.e., moving the head). He had weak grip and extension of the right hand and the triceps of the right arm.

The patient was sent for another MRI of the cervical spine, which revealed huge extrusion of the C6-7 disc with complete occlusion of the right foramen.

Using Inomed Highline ISIS HSG KHBW scenario, discectomy of C6-7 was performed with removal of the extrusion and the osteophytic bone at that area. Routine closure of the wound and smooth postoperative recovery with improvement of the power of the right upper limb.

Using IOM prevent possible complications during surgery, even in the remote sites of the CNS, as in this case the AEP was stable all the time and symmetrical from both sides and SEP with the medianus N20 and tibialis P40 were stable all the time from both sides during the surgery. MEP at times was recorded and it was acceptable. The successive EMG from both glossoph, thenar facials and hypoglossi both sides, were acceptable during the whole procedure.
The preparation for setup for such iom protocol, is time-consuming and with time, the sense of normalcy and when to use such technology will grow and becoming established.