The Memo: Nervio Empowering Safer Surgery Through AI-Driven Neuromonitoring

Under the direction of CEO Rich Vogel, PhD, Nervio is advancing a new layer of AI-powered decision support for intraoperative neurophysiological monitoring (IONM), transforming complex physiologic data streams into real-time alerts and recommendations that help surgical teams detect neurologic risk earlier and more consistently. With its AIM™ platform, Nervio is addressing one of the operating room’s most pressing challenges: a growing volume of spine and neurosurgical procedures, paired with an overstretched and declining neuromonitoring workforce.

Origin Story

Nervio was founded in early 2020 by brothers Dr. Omer Zarchi and Nir Zarchi, inspired by a frontline problem they saw every day in orthopedic and neurosurgery. “Nervio was founded to solve a very practical problem,” Vogel explained. “IONM produces a massive volume of complex physiologic data, yet clinicians are expected to interpret it in real time, under pressure, and with limited decision support amidst a waning workforce.”

As chief neurophysiologist at a large medical center, Dr. Zarchi saw firsthand how staffing shortages and the cognitive intensity of interpretation could delay cases, increase variability, and strain clinical teams. With AI technology maturing, the founders believed the field was ready for a new approach, one that could replicate expert-level interpretation and make high-quality neuromonitoring more scalable.

The company was built on the conviction that AI-enabled decision support will become “a standard layer of the surgical technology stack on a global scale.”

“I joined Nervio because I spent my career in IONM and have seen both its value and its limitations up close,” Vogel said. “The data in IONM is incredibly rich, but it’s underutilized, and clinicians carry a heavy cognitive burden during surgery. I saw the workforce declining due to burnout while surgical volumes continue to rise.”

For Vogel, the opportunity was clear: leverage AI to protect patients while also supporting clinicians under increasing strain.

“The opportunity to improve patient safety while also helping an overstretched workforce do more with less was compelling to me.”

The Current Landscape

IONM is an essential safeguard in spine and neurosurgical procedures, where even small delays or errors can have lifelong consequences. Yet the field remains highly manual, requiring expert interpretation of noisy physiologic data in real time.

During surgery, neurophysiologists must continuously filter artifacts, detect meaningful changes, and communicate actionable alerts quickly. According to Vogel, the current workflow is variable, taxing, and limited by the availability of specialized professionals.

“Today’s standard is human-driven interpretation of IONM signals supported by traditional monitoring systems that primarily acquire and display data in a format that’s only understood by expert neurophysiologists,” he said. “There is limited embedded decision support, and significant variability exists across providers and centers.”

At the same time, demand for neuromonitoring is rising rapidly. According to the Nervio team, more than one million spine and neurosurgical procedures in the U.S. each year utilize IONM, and volumes are growing at an estimated 6% CAGR. However, the supply of highly trained neuromonitoring professionals is increasing by less than 1% year over year.

“That mismatch between case volume and workforce capacity is increasing, with 2026 seeing the first-ever negative supply-demand ratio, which is expected to worsen in the years ahead,” Vogel emphasized.

The result is an environment where decision support and workflow efficiency are becoming critical, not optional.

Inside the Innovation

Nervio’s solution is AIM, the first and only AI-powered neuromonitoring solution that converts raw surgical data into real-time alerts and recommendations. Built on state-of-the-art machine learning algorithms and tested across more than 1,000 surgeries, AIM functions as an intelligent layer that sits on top of existing IONM infrastructure.

“Nervio’s software ingests IONM data streams and uses AI in real time to help identify meaningful signal changes, reduce false alarms, and support standardized interpretation,” Vogel explained. “The clinician remains in control; we aim to make their job easier, faster, and more consistent.”

Rather than replacing clinicians, Nervio is focused on supporting them.

“We design with clinicians and for clinicians,” Vogel said. “Our AI supports human judgment rather than trying to bypass it.”

From a technical standpoint, the platform analyzes multimodal IONM data, performs automated signal quality checks, extracts key features, and applies machine learning models trained on large, expert-annotated datasets. The goal is to distinguish artifacts from true neurologic change and present clear decision support in real time, integrated directly into surgical workflows.

The company believes its differentiation stems from deep domain focus, real-world workflow integration, and a clinician-first philosophy, avoiding the common pitfalls of generic AI healthcare solutions.

“We live and breathe clinical neurophysiology, AI, and data science,” Vogel said. “We are not a generic ‘AI for healthcare’ company.”

Progress and Milestones

Nervio is currently in an advanced development and validation phase. “Our technology is deployed in hospital settings as part of system validation, with ongoing data collection, model development, and clinical validation activities,” he said.

Recent milestones include expanding clinical data partnerships, progressing validation workstreams, and establishing commercial partnerships. The company has also reached a stage where AIM can be demonstrated live, an important step toward market entry.

Looking ahead, Nervio expects: 

• Continued expansion of its AI models across modalities and procedures through strategic alliances with key MedDev, medtech, and OEM corporations
• Deeper integration into neuromonitoring workflows and existing platforms, including imaging/navigation and anesthesiology
• Progression along regulatory pathways
• Increased clinical evidence through studies and collaborative research

“Our long-term vision is to become the physiologic intelligence layer for neuromonitoring in surgery,” Vogel said.

To support these next steps, Nervio has initiated a $5 million Round A subscription to fund R&D, regulatory milestones, and early commercial activities.

“This round allows us to conduct strategic partnering activities and initiate market entry,” Vogel explained. “It bridges us from advanced development to early market entry.”

With procedure volumes rising, workforce constraints tightening, and surgical technology rapidly evolving, Nervio is positioning AIM as a critical support layer for the future of neuromonitoring, improving safety, standardizing interpretation, and helping clinicians meet the demands of a changing operating room environment.

Join Us at LSI USA ‘26

Vogel has been selected to present at LSI USA ‘26, March 16th–20th, in front of hundreds of global medical technology companies. Join us in welcoming him to the event in Dana Point, CA, where he will share the latest updates on Nervio’s technology and development.