The Prevalence of Intraoperative Neuromonitoring in Anterior Cervical Discectomy and Fusion: Trends, Variances, and Value Appraisal.
Journal
Clinical spine surgery
ISSN: 2380-0194
Titre abrégé: Clin Spine Surg
Pays: United States
ID NLM: 101675083
Informations de publication
Date de publication:
30 Oct 2024
30 Oct 2024
Historique:
received:
04
04
2024
accepted:
23
09
2024
medline:
30
10
2024
pubmed:
30
10
2024
entrez:
30
10
2024
Statut:
aheadofprint
Résumé
Retrospective cohort study. 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. 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. 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. 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). 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.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective cohort study.
OBJECTIVE
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
BACKGROUND
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
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 39475121
doi: 10.1097/BSD.0000000000001723
pii: 01933606-990000000-00385
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
D.G.R.: received grants from Duke Bass Connections, a Pfizer Foundation, and the Duke Clinical Translational Science Institute. C.R.G.: received grants from the Robert Wood Johnson Harold Amos Medical Faculty Development Program, the Federal Food and Drug Administration, and the NIH 1R01DE031053-01A1. Consultant for Stryker and Medtronic. Deputy Editor for Spine. Patent Application/invention disclosures outside of the current work. M.M.E.: consultant for Medtronic, Restor3D, Depuy Synthes, and Globus. Received fellowship funding from Globus/Nuvasive and Medtronic. The remaining authors declare no conflict of interest.
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