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Leaders of Innovative TeleNeurology Patient Care


Nationally recognized as the leading physician practice in remote neurophysiological monitoring and neurodiagnostics.

Our team helps clients ensure their IONM services are backed by professional oversight through people, processes, and technology. Our internal credentialing and management of professional services and resources ensure we can offer clients sustainable surgery coverage.

Neurologist oversight for real-time neuromonitoring of over 45,000 orthopedic, neurosurgical, cardiovascular, and otologic surgeries annually.

We employ 18+ physicians who collectively provide services in all 50 states across the country.

Physician credentials in over 700 hospitals and providing services in over 1,300 health care facilities.

We have the ability to partner with diverse clients such as technical services providers, physician practices, hospitals or health care systems.

RTNA staff support several professional medical organizations including the AAN, ASNM, AES, ACNS, and ASET.  Together, they serve on several boards as well as national committees and advisory groups, insurance payor committees, and committees that develop graduate competencies and curricula in electrodiagnostics. We have a presence in organized medicine on the state level and within the AMA, as well as an individual who serves as the medical director for Vanderbilt University’s Electroneurodiagnostic Technology Training Program. In addition to serving as a resource for regulatory and practice issues in IONM, we provide lectures on various topics in neurophysiology and neurodiagnostics including those for both technologists and physicians.


In order to fulfill the needs of neurophysiology monitoring companies, RTNA has developed a state of the art monitoring TeleNeurology and Neurophysiological platform. We help ensure your organization provides the highest level of neurological patient care.

Our Frequently Monitored Surgeries

Anterior Cervical Decompression and Fusion (ACDF)
Anterior Lumbar Interbody Fusion (ALIF)
Carotid Endarterectomy
Direct Lateral Interbody Fusion (DLIF)
Lateral Lumbar Interbody Fusion (LLIF)
Oblique Lumbar Interbody Fusion (OLIF)
Posterior Lumbar Decompression and Fusion (PLDF/PLF)
Posterior Lumbar Interbody Fusion (PLIF)
Posterior Spinal Fusion (PSF)
Removal/Revision of Hardware

Test Modalities

Below is a list of the tests (modalities) most commonly interpreted by our physicians:

Somatosensory Evoked Potentials (SSEP)

Somatosensory evoked responses are performed by placing an electrode on the skin or inserting a needle near the nerve being tested. This electrode delivers an electrical signal, and the response to that signal is measured at various points as it travels through the nervous system to the brain. This modality provides information about the integrity of the sensory pathways and has many uses, including spinal cord monitoring, detecting limb positioning problems, monitoring brainstem and cortical perfusion, and mapping sensory areas of the brain.

Electromyography (EMG)

Electromyography is used to monitor nerves by recording activity in the muscles innervated by those nerves. This muscle activity can either be spontaneous (free-run EMG) or elicited by stimulating the nerve with a probe held by the surgeon (triggered or evoked EMG). EMG is performed by inserting tiny electrodes over specific muscles. If the nerve connected to the muscle is stimulated or irritated, an electrical signal travels to the muscle and makes the muscle contract. The recorded responses are monitored to identify potential risk to the nerve and help prevent permanent damage. Triggered EMG can be used to locate nervous tissue in the surgical field, test the integrity of nervous tissue, or test for safe placement of pedicle screws. Spontaneous and triggered EMG can be used to monitor spinal nerves and some of the cranial nerves.

Pedicle screw stimulation is triggered EMG obtained by stimulating a screw placed in the pedicle of a vertebra. As a nerve root lies immediately beneath each pedicle, an EMG response obtained at too low a stimulus intensity level indicates a breach or hole in the bone. This test modality is used to avoid nerve root damage caused by such a breach. Pedicle screw stimulation is routinely performed in scoliosis correction procedures and when instrumentation is placed for spinal instability.

Transcranial Motor Evoked Potentials (TcMEP)

Transcranial motor evoked potentials are used to monitor the motor pathways in the spinal cord and brain. TcMEPs are performed by applying a mild electrical current across the motor cortex of the brain and recording responses in specific muscles. The muscle responses are recorded and monitored to ensure that the signal traveling through the motor pathways is not interrupted.

Brainstem Auditory Evoked Potentials (BAEPs)

Brainstem auditory evoked potentials record the brainstem’s response to an auditory stimulus by monitoring the function of the auditory pathways. Responses are obtained by delivering click stimuli to each ear through small foam earphones inserted into the ear canal. The response to those clicks can be followed through the auditory pathway from the cochlea (inner ear) to the brainstem. Brainstem auditory evoked potentials are monitored to identify potential risk to the auditory nerve or brainstem and help prevent permanent damage.

Electroencephalography (EEG)

Electroencephalography is used to monitor the function of the cerebral cortex of the brain. Electrodes are placed at several locations on the scalp to record ongoing brain activity. This provides immediate feedback about the function of cortical brain cells. Electroencephalography can be used in all types of surgeries but is most often used in vascular procedures to monitor blood flow to the brain. In cranial surgeries, the recording electrodes can also be placed directly on the exposed surface of the brain; this is called electrocorticography.
Pedicle screw stimulation is triggered EMG obtained by stimulating a screw placed in the pedicle of a vertebra. As a nerve root lies immediately beneath each pedicle, an EMG response obtained at too low a stimulus intensity level indicates a breach or hole in the bone. This test modality is used to avoid nerve root damage caused by such a breach. Pedicle screw stimulation is routinely performed in scoliosis correction procedures and when instrumentation is placed for spinal instability.

Cortical Mapping / Direct Cortical Stimulation

This is used to identify and map the sections of the brain generating seizures for epilepsy surgery, as well as the regions that are responsible for motor skills during tumor resection surgery. Cortical mapping of motor areas is performed by stimulating the designated areas of the brain with a very mild electrical current. As the motor areas are stimulated, muscle responses will be recorded in the part of the body that corresponds to that area of the motor cortex.

Phase reversal is a type of mapping that involves stimulating the upper extremities at the wrists (SSEPs, as described above) and recording from electrodes placed directly on the surface of the brain. A certain pattern of responses helps the surgeon locate the parts of the brain responsible for sensory versus motor function. This is helpful in tumor removal surgeries so that the surgeon can remove tumor without damaging areas of the brain that are responsible for movement.

Transcranial Doppler (TCD)

This test measures the blood flow velocity in the internal arteries of the brain using an ultrasound beam. It is used to assess the risk of stroke and monitor cerebral blood flow in procedures such as cardiothoracic sugeries. TCD is done with electrodes placed on the skin on the temple, the base of the skull at the back of the neck, and over the closed eyelid. The clinician adjusts a probe to direct sound waves toward the blood vessels of interest, and the blood flow sounds in specific blood vessels are recorded and analyzed.

Cranial Nerve Monitoring

This testing is used to protect cranial nerves during surgery.   Cranial nerves are particularly susceptible to damage by mechanical trauma and ischemia during intracranial and extracranial surgery.  The use of cranial nerve monitoring can prevent or reduce neurological injuries associated with surgery.  A number of reliable electrodiagnostic techniques have been adapted specifically to identify and evaluate cranial nerve function during surgery, including electromyography and nerve conduction studies.

Cranial nerve Electromyography (EMG):  The evaluation of spontaneous and evoked electromyogenic activity can be extremely useful in monitoring cranial nerve function.  Spontaneous EMG activity in the anatomical distribution of these nerves can signal irritation of the cranial nerve.

Compound Nerve Action Potential (CNAP):  This test is used to monitor cranial or peripheral nerves using electrodes to record nerve activity at one location while the nerve is being electrically stimulated at another location. CNAP is used to assess the function of a nerve and can also be used to map or identify a lesion in the nerve.  Frequent direct stimulation of the specific nerve enables the neuromonitoring team to assist the surgeon and prevent damage to the nervous structures. 

Transcranial Cerebral Oximetry (TCCO)

Transcranial cerebral oximetry is used to monitor changes in saturation of oxygen within a sample of blood in the cerebral cortex. Measurements are made by non-invasively transmitting and detecting low intensity, near-infrared light through electrodes placed on both sides of the patient's forehead. TCCO allows technologists to detect changes in the brain’s blood oxygen saturation which may require corrective action by the surgical team to prevent or reduce neurological injuries.

Partner Organizations

Allied Managed Processes, LLC

Allied Managed Processes, LLC (AMP) is a practice partner of Real Time Neuromonitoring Associates. AMP provides staffing: recruitment, human resources and employee benefits management; information technology: infrastructure, server and help desk services; marketing: website-design and optimization; and finance and accounting services. Contact Allied Managed Processes, LLC (AMP) for further information about our business partners.

Real Time Tele-Epilepsy Consultants

Real Time Tele-Epilepsy Consultants (RTTC) is a physician-led organization and practice partner of Real Time Neuromonitoring Associates. RTTC delivers expert, high quality EEG interpretation and customizable tele-epilepsy consultation services via telehealth to hospitals, outpatient facilities and ambulatory EEG companies.

Interested in TeleNeurology? Consider joining our team

Office: (615) 346-8182
(877) 836-2408
Billing: (855) 854-5600

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