The Prevalence of Intraoperative Neuromonitoring in Anterior Cervical Discectomy and Fusion: Trends, Variances, and Value Appraisal

Dana G Rowe; Connor Barrett; Edwin Owolo; Nicole Rivera; Eli Johnson; Jihad Abdelgadir; Kerri-Anne Crowell; C Rory Goodwin; Melissa M Erickson

doi:10.1097/BSD.0000000000001723

The Prevalence of Intraoperative Neuromonitoring in Anterior Cervical Discectomy and Fusion: Trends, Variances, and Value Appraisal

Clin Spine Surg. 2024 Oct 30. doi: 10.1097/BSD.0000000000001723. Online ahead of print.

Authors

Dana G Rowe¹, Connor Barrett¹, Edwin Owolo¹, Nicole Rivera¹, Eli Johnson², Jihad Abdelgadir², Kerri-Anne Crowell³, C Rory Goodwin², Melissa M Erickson⁴

Affiliations

¹ Duke University School of Medicine.
² Department of Neurosurgery, Duke University Medical Center.
³ Biostatistics Shared Resource, Duke Cancer Institute.
⁴ Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.

PMID: 39475121
DOI: 10.1097/BSD.0000000000001723

Abstract

Study design: Retrospective cohort study.

Objective: The purpose of this study was to (1) evaluate recent trends in the use of intraoperative neuromonitoring (IONM) for anterior cervical discectomy and fusion (ACDF) in the United States, (2) assess regional variations in the use of IONM, and (3) assess the association between IONM and clinical outcomes.

Summary of background data: IONM is frequently used during anterior cervical procedures to mitigate the risk of neurological injury. Prior studies have demonstrated decreasing utilization of IONM in ACDFs. However, no recent studies have re-assessed these trends.

Methods: Cases of cervical myelopathy and radiculopathy that underwent ACDF from 2011 to 2021 were identified through the PearlDiver Patient Record Database. Rates of IONM were compared based on patient age, gender, income, and region. Complications, 30-day readmissions, and reimbursement rates were also assessed.

Results: We identified 285,939 patients undergoing isolated ACDF, with 45,943 (16.1%) of these cases using IONM. There was a significant increase in the use of IONM for ACDFs over the study period (R2=0.87, P<0.001). Significant regional variability was observed in the utility of IONM (Northeast; 21.2%, Midwest; 16.3%, South; 14.7%, West; 14.2%; P<0.001). Younger age and higher patient income were associated with increased utility of IONM (P<0.001). IONM was associated with significantly higher costs but no reduction in rates of postoperative neurological complications (P<0.001 and 0.29, respectively).

Conclusion: This study demonstrates a significant increase in IONM utilization during ACDFs over the past decade. Considerable differences exist in IONM use concerning patient demographics, income, and geographic region, with the highest utilization in the Northeast. Notably, despite the association of IONM with over a 20% increase in reimbursement rates, its implementation was not associated with a reduction in rates of neurological complications.