3 December 2015 – Volume 15 – Issue 23 – p 18–19
The question of whether intraoperative neurophysiological monitoring provides any benefit for so-called “low risk” spinal surgeries such as decompression and simple fusion has been the focus of some debate. Skeptics say monitoring is not necessary for straightforward spinal procedures and that it is overused, increasing the cost of surgery.
A new analysis of a large national inpatient dataset found, however, that intraoperative monitoring (IOM) significantly reduced the rate of neurologic complications in patients who underwent spinal decompressions or simple fusions compared with patients who were not monitored. The difference in the neurologic complication rate was 0.8 percent for the IOM group compared with 1.4 percent for the non-IOM group.
They looked at a sample of 10,867 cases involving IOM and 223,200 cases that did not involve monitoring, representing an estimated 1.1 million discharges. The complications rate was 2.7 percent with no monitoring, compared with 1.7 percent with monitoring; there were no significant differences in complication rates associated with anterior cervical fusions among the groups.
Although focused on comparatively low risk surgeries, the clinical impact of IOM suggested by analysis is substantial, the researchers concluded. The main clinical outcome of IOM use is a reduction in neurological complications by nearly half, this is important even when the risk is less than 2 percent This study provides important evidence for the value of IOM in even so-called low risk surgeries.
It is important to appreciate that only 4.9 percent of such surgeries utilized IOM. As such, there are potentially many more neurologic complications that can be avoided. From a quality of life perspective, the addition of IOM during spine surgery could have immeasurable value.