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Dr Langer Medical - AVALANCHE® PLUS

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in neurosurgery and spine surgery

​​What is IONM? 


Surgeries are inherently risky, especially those that involve the brain, spinal cord or nerves. Intraoperative neurophysiological monitoring (IONM) is performed during many different types of surgeries to reduce the risk of devastating, irreversible neurological deficits, such as muscle weakness, loss of sensation, hearing loss and impairment of essential bodily functions.

IONM involves multi modal recording of electrical potentials from the nervous system during operations to detect adverse changes, enable corrective action, and offer surgical guidance.

Neuromonitoring in neurosurgery

Intraoperative neuromonitoring of the cranial nerves and central nervous system is routine during neurosurgical interventions.

If a mass makes functionally important areas of the brain unidentifiable during surgery, AVALANCHE® PLUS can help you to find access to the tumour tissue with as little damage as possible, while preserving the brain areas. The function of many cranial nerves can also be controlled with the help of multimodal neuromonitoring.

Neuromonitoring in spine surgery

The spinal cord includes the descending motor nerves that mainly carry impulses from the brain to the muscles, as well as the ascending sensory pathways that transmit information from the peripheral sensory organs to the brain. 

There is a general distinction between neuromonitoring of efferent (descending) motor pathways via EMG (electromyography) and motor evoked potentials (MEP), and neuromonitoring of afferent (ascending) pathways using somatosensory evoked potentials (SEP). 

What at first glance seems very complex, could be extremely easy with our AVALANCHE® PLUS. In surgical scenarios, where a combination of the different methods is required and measurements are taken simultaneously, AVALANCHE® PLUS has a completely new approach.

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32-channel neuromonitor for spine surgery

The PLUS concept:
Focusing on essentials

Exactly the neuromonitor you always wanted.
Discover our AVALANCHE® PLUS , a completely new approach to IONM. You will be inspired by its clear structure and intuitive operation.

Can a 32-channel system get any simpler?

Learning the system functions of the AVALANCHE® PLUS is a cinch. Quickly determine your signal channels from the visual display and control everything directly via touch screen.

Your EMG, SEP and MEP signals stay reliably in view during surgery.

Design meets functionality 

whether with a stylish cart or as a slim desktop device.

IONM in a novel concept


Visual configuration

Simply select individual muscle groups and assign them to the desired measuring window. Assign the connectors and your configuration is done.

The markers make it easy to retrace lead assignment at any time.

The process is even easier for SEP.

AVALANCHE® PLUS comes with predefined signal channels. Create your measuring window with the touch of a button. The system automatically assigns the stimulators. Choose the electrode connections and you are ready to go. 


Setup can be that easy.

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Working hand in hand with your system


The PLUS concept:
Patient connections made easy.

Colour and shape-coded connectors on the stimulator ensure the unequivocal allocation of connectors to the matching socket.

AVALANCHE® PLUS can do even more: 
It helps you connect the lead electrodes. When you select a muscle on the screen, a white LED will display the proper connection. The muscle is highlighted in the anatomical overview. You can immediately recognise the electrode position and connector socket.


Once the electrode has been placed, AVALANCHE® PLUS will continuously check the electrode contact. Green stands for excellent contact, while yellow means that contact is sufficient and red indicates a loss of contact.


Everything in view ...


... you stay in control.

The large touch screen of the AVALANCHE® PLUS keeps all essential signals and signal changes in view.

Open and apply saved measuring configurations at any time.

Change stimulator parameters directly from the main windowvia quick stimulator access.

Documentation at the push of a button.

Create screenshots in a single step. Simply select events and generate a PDF report - done!

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