Intraoperative Neuromonitoring Use Patterns in Degenerative, Nondeformity Cervical Spine Surgery: A Survey of the Cervical Spine Research Society.

STUDY

DESIGN

A cross-sectional survey study.

OBJECTIVE

To determine the neuromonitoring (NM) usage patterns among cervical spine surgeons when performing degenerative, nondeformity cervical spine surgery.

SUMMARY OF BACKGROUND DATA: Intraoperative NM is frequently used in spine surgery. Although there is literature to support the use of NM in deformity surgery, its utility in degenerative cervical spine surgery remains unclear.

MATERIALS AND

METHODS

A survey was distributed to members of the Cervical Spine Research Society to assess practice patterns of NM use during degenerative cervical spine surgery. The survey consisted of 17 multiple choice questions. The first 3 questions focus on practice experience. The remaining 14 questions pertain to NM practice patterns in the setting of radiculopathy and myelopathy.

RESULTS

Significantly more surgeons routinely (>75% of the time) used NM for myelopathy versus radiculopathy (64% vs. 38%, P<0.001). Private practitioners were overall more likely to use NM than academicians (55% vs. 28%, P=0.007 for radiculopathy; 75% vs. 57%, P=0.09 for myelopathy). No significant difference in NM usage was found comparing neurosurgeons and orthopedic spine surgeons. The most commonly cited primary reasons for NM usage were prevention of positioning/hypotension-related neurological complications, and medicolegal protection.

CONCLUSIONS

Routine NM use during degenerative cervical surgery is significantly more common in myelopathy and is thought to be of more value than in radiculopathy. However, the most common reasons for usage were to provide medicolegal cover and to mitigate neurological complications related to positioning/hypotension, rather than to protect against direct surgical events. These findings contrast the prevailing notion that NM is beneficial in reducing complications related to events occurring in the surgical site when performing spinal deformity correction. We believe that these data provide an important baseline for informing best practice guidelines and further study regarding appropriate NM use for degenerative, nondeformity, cervical spine surgery.