Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy

Resnick, Daniel K.; Anderson, Paul A.; Kaiser, Michael G.; Groff, Michael W.; Heary, Robert F.; Holly, Langston T.; Mummaneni, Praveen V.; Ryken, Timothy C.; Choudhri, Tanvir F.; Vresilovic, Edward J.; Matz, Paul G.

doi:10.3171/2009.2.spine08730

Cited by 68 publications

(44 citation statements)

References 28 publications

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“…6 Similar to lack of consensus for low-risk lumbar surgeries, there is not yet consensus supporting the use of IONM during low-risk cervical spine surgeries. 15 Indeed, our study showed no difference in independence at discharge between patients in whom IONM was used versus patients in whom IONM was not used during elective anterior cervical discectomy and fusion surgery. The absence of IONM use during low-risk cervical spine surgery is supported by other studies that have reported a lack of iatrogenic nerve and spinal cord injury among patients who underwent cervical spine surgery without use of IONM.…”

Section: Discussionmentioning

confidence: 90%

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

James

Rughani

Dumont

2014

FOC

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Object In the United States in recent years, a dramatic increase in the use of intraoperative neurophysiological monitoring (IONM) during spine surgeries has been suspected. Myriad reasons have been proposed, but no clear evidence confirming this trend has been available. In this study, the authors investigated the use of IONM during spine surgery, identified patterns of geographic variation, and analyzed the value of IONM for spine surgery cases. Methods In this retrospective analysis, the Nationwide Inpatient Sample was queried for all spine surgeries performed during 2007–2011. Use of IONM (International Classification of Diseases, Ninth Revision, code 00.94) was compared over time and between geographic regions, and its effect on patient independence at discharge and iatrogenic nerve injury was assessed. Results A total of 443,194 spine procedures were identified, of which 85% were elective and 15% were not elective. Use of IONM was recorded for 31,680 cases and increased each calendar year from 1% of all cases in 2007 to 12% of all cases in 2011. Regional use of IONM ranged widely, from 8% of cases in the Northeast to 21% of cases in the West in 2011. Iatrogenic nerve and spinal cord injury were rare; they occurred in less than 1% of patients and did not significantly decrease when IONM was used. Conclusions As costs of spine surgeries continue to rise, it becomes necessary to examine and justify use of different medical technologies, including IONM, during spine surgery.

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Section: Discussionmentioning

confidence: 90%

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

James

Rughani

Dumont

2014

FOC

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“…1,11,15,19,34,42 Many developments have occurred since IOM was first used, 8 and currently SSEPs are used to assess the dorsal afferent tracts, 35 while MEPs are used for monitoring the motor tracts of the spinal cord. The utility and accuracy of each monitoring modality may be affected by the type of surgery, patient condition, anesthesia, and physiological changes during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…4,16,22,23,27,30,34,42 Signal changes such as increased latency (typically greater than 10% prolongation) and decreased amplitude (typically greater than 40% reduction) trigger concern for possible neurological injury, 25 yet these signal changes do not always correlate with the development of a postoperative deficit.…”

Section: -1118mentioning

confidence: 99%

Cervical decompression and reconstruction without intraoperative neurophysiological monitoring

Traynelis

Abode-Iyamah

Slingluff

et al. 2012

SPI

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Object The primary goal of this study was to review the immediate postoperative neurological function in patients surgically treated for symptomatic cervical spine disease without intraoperative neurophysiological monitoring. The secondary goal was to assess the economic impact of intraoperative monitoring (IOM) in this patient population. Methods This study is a retrospective review of 720 consecutively treated patients who underwent cervical spine procedures. The patients were identified and the data were collected by individuals who were not involved in their care. Results A total of 1534 cervical spine levels were treated in 720 patients using anterior, posterior, and combined (360°) approaches. Myelopathy was present preoperatively in 308 patients. There were 185 patients with increased signal intensity within the spinal cord on preoperative T2-weighted MR images, of whom 43 patients had no clinical evidence of myelopathy. Three patients (0.4%) exhibited a new neurological deficit postoperatively. Of these patients, 1 had a preoperative diagnosis of radiculopathy, while the other 2 were treated for myelopathy. The new postoperative deficits completely resolved in all 3 patients and did not require additional treatment. The Current Procedural Terminology (CPT) codes for IOM during cervical decompression include 95925 and 95926 for somatosensory evoked potential monitoring of the upper and lower extremities, respectively, as well as 95928 and 95929 for motor evoked potential monitoring of the upper and lower extremities. In addition to the charge for the baseline [monitoring] study, patients are charged hourly for ongoing electrophysiology testing and monitoring using the CPT code 95920. Based on these codes and assuming an average of 4 hours of monitoring time per surgical case, the savings realized in this group of patients was estimated to be $1,024,754. Conclusions With the continuing increase in health care costs, it is our responsibility as providers to minimize expenses when possible. This should be accomplished without compromising the quality of care to patients. This study demonstrates that decompression and reconstruction for symptomatic cervical spine disease without IOM may reduce the cost of treatment without adversely impacting patient safety.

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“…Therefore, some surgeons would suggest early surgery for patients with CSM to ameliorate the risk of SCI. 2,9,19,21,22,24,27,33 However, there are insufficient data to correlate CSM with SCI, and whether the risk of SCI can be altered by surgical intervention remains elusive.…”

mentioning

confidence: 99%

Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

Chen¹,

Chen³

et al. 2016

FOC

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OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups. RESULTS Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p < 0.001 and p = 0.007, respectively). Surgery could significantly lower the risk for approximately 50% of patients (HR 0.52, p < 0.001). CONCLUSIONS Patients with CSM had an overall incidence rate of SCI at approximately 0.2% per year. Male sex, the coexistence of OPLL, and conservative management are twice as likely to be associated with subsequent SCI. Surgery is therefore suggested for male patients with CSM who also have OPLL.

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Electrophysiological monitoring during surgery for cervical degenerative myelopathy and radiculopathy

Cited by 68 publications

References 28 publications

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

A socioeconomic analysis of intraoperative neurophysiological monitoring during spine surgery: national use, regional variation, and patient outcomes

Cervical decompression and reconstruction without intraoperative neurophysiological monitoring

Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

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