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. 2023 Aug 1;48(15):1095-1106.
doi: 10.1097/BRS.0000000000004603. Epub 2023 Apr 11.

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

Yusuke Dodo  1   2 , Ichiro Okano  1   2 , William D Zelenty  1 , Samuel Paek  1   3 , Michele Sarin  1 , Henryk Haffer  1 , Maximilian Muellner  1 , Erika Chiapparelli  1 , Jennifer Shue  1 , Ellen Soffin  4 , Darren R Lebl  1 , Frank P Cammisa  1 , Federico P Girardi  1 , Gbolabo Sokunbi  1 , Andrew A Sama  1 , Alexander P Hughes  1
Affiliations

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

Yusuke Dodo et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective database analysis.

Objective: To elucidate trends in the utilization of intraoperative neurophysiological monitoring (IONM) during elective lumbar surgery procedures and to investigate the association between the use of IONM and surgical outcomes.

Background: The routine use of IONM in elective lumbar spine procedures has recently been called into question due to longer operative time, higher cost, and other substitute advanced technologies.

Methods: The Statewide Planning and Research Cooperative System database was accessed to perform this retrospective study. The trends of IONM use for lumbar decompression and fusion procedures were investigated from 2007 to 2018. The association between IONM use and surgical outcomes was investigated from 2017 to 2018. Multivariable logistic regression analyses, as well as propensity score matching (PS-matching), were conducted to assess IONM association in neurological deficits reduction.

Results: The utilization of IONM showed an increase in a linear fashion from 79 cases in 2007 to 6201 cases in 2018. A total of 34,592 (12,419 monitored and 22,173 unmonitored) patients were extracted, and 210 patients (0.6%) were reported for postoperative neurological deficits. Unadjusted comparisons demonstrated that the IONM group was associated with significantly fewer neurological complications. However, the multivariable analysis indicated that IONM was not a significant predictor of neurological injuries. After the PS-matching of 23,642 patients, the incidence of neurological deficits was not significantly different between IONM and non-IONM patients.

Conclusion: The utilization of IONM for elective lumbar surgeries continues to gain popularity. Our results indicated that IONM use was not associated with a reduction in neurological deficits and will not support the routine use of IONM for all elective lumbar surgery.

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Conflict of interest statement

A.A.S. reports royalties from Ortho Development, Corp.; private investments for Vestia Ventures MiRUS Investment, LLC, ISPH II, LLC, ISPH 3, LLC, and VBros Venture Partners X Centinel Spine; consulting fee from Clariance, Inc., Kuros Biosciences AG, and Medical Device Business Service, Inc.; speaking and teaching arrangements of DePuy Synthes Products, Inc.; membership of scientific advisory board of Clariance, Inc., and Kuros Biosciences AG; and trips/travel of Medical Device Business research support from Spinal Kinetics, Inc., outside the submitted work. F.P.C. reports royalties from NuVasive, Inc.; private investments for 4WEB Medical/4WEB, Inc., Accelus, Bonovo Orthopedics, Inc., Healthpoint Capital Partners, LP, ISPH II, LLC, ISPH 3 Holdings, LLC, Ivy Healthcare Capital Partners, LLC, Medical Device Partners II, LLC, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, Tissue Differentiation Intelligence, LLC, VBVP VI, LLC, VBVP X, LLC (Centinel) and Woven Orthopedics Technologies; consulting fees from 4WEB Medical/4WEB, Inc., DePuy Synthes Spine, NuVasive, Inc., Spine Biopharma, LLC, and Synexis, LLC; membership of scientific advisory board/other office of Healthpoint Capital Partners, LP, Medical Device Partners III, LLC, Orthobond Corporation, Spine Biopharma, LLC, Synexis, LLC, and Woven Orthopedic Technologies; and research support from 4WEB Medical/4WEB, Inc., Mallinckrodt Pharmaceuticals, Camber Spine, and Centinel Spine, outside the submitted work. F.P.G. reports royalties from Lanx, Inc., and Ortho Development Corp.; private investments for Centinel Spine, and BCMID; stock ownership of Healthpoint Capital Partners, LP; and consulting fees from NuVasive, Inc., and DePuy Synthes Spine, outside the submitted work. A.P.H. reports research support from NuVasive, Inc. and Kuros Biosciences AG; and fellowship support from NuVasive, Inc. and Kuros Biosciences AG, outside the submitted work. D.R.L. reports royalties from NuVasive, Inc and Stryker; private investments from HS2, LLC, Woven Orthopedic Technologies, Vestia Ventures MiRus Investiment LLC, ISPH, LLC; consulting fee from Depuy Synthes, Vizeon, Inc; scientific advisory board from Remedy Logic; and research support from Medtronic. The remaining authors report no conflicts of interest.

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