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

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Spine Surgery Pub Date : 2024-10-30 DOI:10.1097/BSD.0000000000001723

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

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引用次数: 0

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.

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颈椎前路切除术和融合术术中神经监测的普及率：趋势、差异和价值评估。

研究设计回顾性队列研究：本研究的目的是：（1）评估美国颈椎前路椎间盘切除和融合术（ACDF）术中神经监测（IONM）使用的最新趋势；（2）评估IONM使用的地区差异；（3）评估IONM与临床结果之间的关联：IONM 经常在颈椎前路手术中使用，以降低神经损伤的风险。之前的研究表明，在 ACDF 中 IONM 的使用率在下降。然而，近期没有研究对这些趋势进行重新评估：方法：通过PearlDiver患者记录数据库确定了2011年至2021年接受ACDF治疗的颈椎脊髓病和根性颈椎病病例。根据患者的年龄、性别、收入和地区比较了IONM的比率。此外，还对并发症、30 天再入院率和报销率进行了评估：我们确定了285,939例接受孤立ACDF手术的患者，其中45,943例（16.1%）使用了IONM。在研究期间，使用IONM进行ACDF的病例明显增加（R2=0.87，PC结论：这项研究表明，在过去十年中，ACDFs中IONM的使用率大幅上升。IONM的使用在患者人口统计学、收入和地理区域方面存在相当大的差异，其中东北部的使用率最高。值得注意的是，尽管 IONM 与报销率增加 20% 以上有关，但其实施与神经系统并发症发生率的降低并无关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.